ISSN:
1432-055X
Keywords:
Schlüsselwörter Hyperglykämie
;
Hypoglykämie
;
regionale Organdurchblutung
;
Microspheres
;
kardiopulmonale Reanimation (CPR)
;
Key words Hyperglycaemia
;
Hypoglycaemia
;
Regional organ blood flow
;
Microspheres
;
Cardiopulmonary resuscitation (CPR)
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract Blood glucose alterations prior to cerebral ischaemia are associated with poor neurologic outcome, possibly due to extensive lactic acidosis or energy failure. Cerebral effects of hyper- or hypoglycaemia during cardiopulmonary resuscitation (CPR) are less well known. In addition, little information is available concerning cardiac effects of blood glucose alterations. The aim of this study was to evaluate the effects of pre-cardiac-arrest hypo- or hyperglycaemia compared to normoglycaemia upon haemodynamics, cerebral blood flow (CBF) and metabolism (CMRO2), and regional cardiac blood flow during CPR subsequent to 3 min of cardiac and respiratory arrest and after restoration of spontaneous circulation. Methods. After approval by the State Animal Investigation Committee, 29 mechanically ventilated, anaesthetised pigs were instrumented for haemodynamic monitoring and blood flow determination by the radiolabeled microsphere technique. The animals were randomly assigned to one of three groups: in group I (n=9) blood glucose was not manipulated; in group II (n=10) blood glucose was increased by slow infusion of 40% glucose to 319±13 mg/dl; in group III (n=10) blood glucose was lowered by careful titration with insulin to 34±2 mg/dl. After 3 min of untreated ventricular fibrillation and respiratory arrest, CPR (chest compressor/ventilator (Thumper®) and epinephrine infusion) was commenced and continued for 8 min. Thereafter, defibrillation was attempted, and if successful, the animals were observed for another 240 min. Cerebral perfusion pressure (CPP), CBF, CMRO2, coronary perfusion pressure (CorPP), and regional cardiac blood flow were determined at control, after 3 min of CPR, and at 10, 30, and 240 min post-CPR. Results. In group I, 4/9 animals (44%) could be successfully resuscitated; in group II 4/10 (40%); and in group III 0/10 (0%). Prior to cardiac arrest, mean arterial pressure, CPP, and CorPP in group III were significantly lower compared to groups I and II. In group I, CPP during CPR was 26±6 mmHg; CBF 31±9 ml/min/100 g CMRO2 3.8±1.2 ml/min/100 g; CorPP 18±5 mmHg; and left ventricular (LV) flow 35±15 ml/min/100 g. In group II: CPP=21±5; CBF 21±7; CMRO2 1.8±0.8; CorPP 16±6; and LV flow 22±9; and in group III: CPP 15±3; CBF 11±8; CMRO2 1.5±1.1; CorPP 4±2; and LV flow 19±10. During the 240-min post-resuscitation period, there were no differences in CBF, CMRO2, or LV flow between groups I and II. Conclusion. Hypoglycaemia prior to cardiac arrest appears to be predictive for a poor cardiac outcome, whereas hyperglycaemia does not impair resuscitability compared to normoglycaemia. In addition, hyperglycaemia did not affect LV flow, CBF, or CMRO2. However, it has to be kept in mind that haemodynamics and organ blood flow do not permit conclusions with respect to functional neurologic recovery or histopathologic damage to the brain, which is very likely to be associated with hyperglycaemia.
Notes:
Zusammenfassung Gegenstand der vorliegenden Untersuchung im Schweinemodell ist der Einfluß einer prä-ischämischen Normo-, Hyper- oder Hypoglykämie auf Hämodynamik, regionale Organdurchblutung und Reanimierbarkeit nach 3minüti-gem unbehandelten Herz-Kreislauf-Stillstand und anschließender kardiopulmonalen Reanimation (CPR). Hypoglykämie (Blutzuckerkonzentration von 34±2 mg/dl) war bereits vor der Reanimation mit einer deutlichen Beeinträchtigung hämodynamischer Parameter assoziiert. Keines der hypoglykämischen Tiere konnte erfolgreich reanimiert werden, im Gegensatz zu den hyper- (Blutzucker 319±13 mg/dl) bzw. normoglykämischen Tieren, die keinen Unterschied hinsichtlich der Erfolgsrate der Reanimation aufwiesen. Weder vor noch während oder nach Reanimation unterschieden sich hyper- und normoglykämische Tiere in bezug auf Hämodynamik oder regionale kardiale oder zerebrale Durchblutung. Somit bleibt festzuhalten, daß Hypoglykämie bei CPR mit einer schlechten kardialen Prognose assoziiert ist, während Hyperglykämie die kardiale Reanimation offenbar nicht beeinträchtigt.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050328
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