Tang Wanchun, Snyder David, Wang Jinglan, Huang Lei, Chang Yun-Te, Sun Shijie, Weil Max Harry
Weil Institute of Critical Care Medicine, 35-100 Bob Hope Dr, Rancho Mirage, California 92270, USA.
Circulation. 2006 Jun 13;113(23):2683-9. doi: 10.1161/CIRCULATIONAHA.105.592121. Epub 2006 Jun 5.
The success of resuscitation with a 1-shock versus the conventional 3-shock defibrillation protocol was investigated subject to the range of treatment variation imposed by automated external defibrillators (AEDs).
Ventricular fibrillation was induced in 44 domestic pigs. After 7 minutes of untreated VF, animals were randomized among 4 groups representing all combinations of the 1- versus 3-shock protocol and 2 different AED regimens (AED1, AED2). Because few AEDs support a 1-shock protocol, manual defibrillators were used to replicate the AED treatment regimen: electrical waveform, dose sequence, and cardiopulmonary resuscitation (CPR) interruption intervals. Initial shock(s) were delivered, followed by 60 seconds of CPR, and the treatment was repeated until resuscitation was successful or for 15 minutes. The 1-shock protocol was associated with improved outcome, reducing CPR interruptions from 45% to 34% of total resuscitation time (P=0.019) and increasing survival from 64% to 100% (P=0.004). Survival was 91% for AED1 versus 36% for AED2 (P=0.024) with a 3-shock protocol but was increased to 100% for both by adoption of a 1-shock protocol. Improvements in postresuscitation left ventricular ejection fraction and stroke volume were observed with AED1 compared with AED2 (difference of means, 15% and 28% of baseline respectively, P<0.001) regardless of defibrillation protocol.
Adoption of a 1-shock versus a 3-shock resuscitation protocol improved survival and minimized outcome differences imposed by variations in AED design and implementation. When a conventional 3-shock defibrillation protocol was used, however, the choice of AED had a significant impact on resuscitation outcome.
在自动体外除颤器（AED）所施加的治疗差异范围内，研究了单次电击复苏与传统三次电击除颤方案的成功率。
对44头家猪诱发室颤。在未经治疗的室颤7分钟后，将动物随机分为4组，分别代表单次电击与三次电击方案以及两种不同AED方案（AED1、AED2）的所有组合。由于很少有AED支持单次电击方案，因此使用手动除颤器来复制AED治疗方案：电波形、剂量顺序和心肺复苏（CPR）中断间隔。先进行初始电击，随后进行60秒的CPR，重复该治疗直至复苏成功或持续15分钟。单次电击方案与更好的结果相关，将CPR中断时间从总复苏时间的45%减少至34%（P=0.019），并将生存率从64%提高至100%（P=0.004）。在三次电击方案中，AED1的生存率为91%，而AED2为36%（P=0.024），但采用单次电击方案后两者均提高至100%。与AED2相比，无论除颤方案如何，使用AED1时复苏后左心室射血分数和每搏输出量均有所改善（平均差异分别为基线的15%和28%，P<0.001）。
采用单次电击而非三次电击复苏方案可提高生存率，并使AED设计和实施差异所带来的结果差异最小化。然而，当使用传统的三次电击除颤方案时，AED的选择对复苏结果有显著影响。
