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Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report
Intensive Care Medicine Experimental Pub Date : 2020-09-04 , DOI: 10.1186/s40635-020-00340-0 Alexander L Lindqwister 1 , Joshua W Lampe 2 , Jeffrey R Gould 2 , Christopher L Kaufman 2 , Karen L Moodie 1 , Norman A Paradis 1, 3
Intensive Care Medicine Experimental Pub Date : 2020-09-04 , DOI: 10.1186/s40635-020-00340-0 Alexander L Lindqwister 1 , Joshua W Lampe 2 , Jeffrey R Gould 2 , Christopher L Kaufman 2 , Karen L Moodie 1 , Norman A Paradis 1, 3
Affiliation
Background Pseudo-pulseless electrical activity (pseudo-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Pseudo-PEA may constitute up to 40% of reported cases of cardiac arrest. Resuscitation from pseudo-PEA is often associated with hypotension refractory to catecholamine pressors. We hypothesized that this post-resuscitation state may be associated with hypocalcemic hypotension responsive to intravenous calcium. Methods Using pre-existing data from our hypoxic swine pseudo-PEA model, we measured blood pressure, hemodynamics, and electrolytes. Physiological data were analyzed on a heartbeat by heartbeat basis. The midpoint of the calcium response was defined using change of curvature feature detection. Hemodynamic parameters were shifted such that the value at the midpoint was equal to zero. Results In 9 animals with refractory hypotension, we administered 37 boluses of intravenous calcium in the dosage range of 5-20 mg. Comparisons were made between the average values in the time period 40-37 s before the midpoint and 35-40 s after the midpoint. Of the 37 administered boluses, 34 manifested a change in the blood pressure, with mean aortic pressure, systolic and diastolic pressures all increasing post bolus administration. Conclusions Administration of intravenous calcium may be associated with a pressor-like response in refractory hypotension after resuscitation from pseudo-PEA. Relative ionized hypocalcemia may cause hypotension after resuscitation from pseudo-PEA. Therapy with intravenous calcium should be further investigated in this setting.
中文翻译:
静脉钙作为缺氧伪无脉冲电动机械活动猪模型中的升压剂——初步报告
背景 伪无脉冲电活动 (pseudo-PEA) 是一种无生命形式的严重心脏休克,其特征是可测量的心脏机械活动,而临床上可检测到的脉冲。伪 PEA 可能占报告的心脏骤停病例的 40%。假性 PEA 的复苏通常与儿茶酚胺升压剂难治的低血压有关。我们假设这种复苏后状态可能与对静脉钙有反应的低血钙性低血压有关。方法 使用来自我们的缺氧猪伪 PEA 模型的预先存在的数据,我们测量了血压、血流动力学和电解质。在逐个心跳的基础上分析生理数据。使用曲率变化特征检测来定义钙响应的中点。血流动力学参数被改变,使得中点处的值等于零。结果 在 9 只顽固性低血压动物中,我们以 5-20 毫克的剂量范围注射了 37 次静脉钙剂。比较中点前40-37s和中点后35-40s时间段的平均值。在 37 次给药后,34 次出现血压变化,平均主动脉压、收缩压和舒张压均在给药后增加。结论 静脉补钙可能与假性 PEA 复苏后顽固性低血压的升压样反应有关。从假性 PEA 复苏后,相对电离低钙血症可能导致低血压。
更新日期:2020-09-04
中文翻译:
静脉钙作为缺氧伪无脉冲电动机械活动猪模型中的升压剂——初步报告
背景 伪无脉冲电活动 (pseudo-PEA) 是一种无生命形式的严重心脏休克,其特征是可测量的心脏机械活动,而临床上可检测到的脉冲。伪 PEA 可能占报告的心脏骤停病例的 40%。假性 PEA 的复苏通常与儿茶酚胺升压剂难治的低血压有关。我们假设这种复苏后状态可能与对静脉钙有反应的低血钙性低血压有关。方法 使用来自我们的缺氧猪伪 PEA 模型的预先存在的数据,我们测量了血压、血流动力学和电解质。在逐个心跳的基础上分析生理数据。使用曲率变化特征检测来定义钙响应的中点。血流动力学参数被改变,使得中点处的值等于零。结果 在 9 只顽固性低血压动物中,我们以 5-20 毫克的剂量范围注射了 37 次静脉钙剂。比较中点前40-37s和中点后35-40s时间段的平均值。在 37 次给药后,34 次出现血压变化,平均主动脉压、收缩压和舒张压均在给药后增加。结论 静脉补钙可能与假性 PEA 复苏后顽固性低血压的升压样反应有关。从假性 PEA 复苏后,相对电离低钙血症可能导致低血压。