Rea Thomas D, Helbock Michael, Perry Stephen, Garcia Michele, Cloyd Don, Becker Linda, Eisenberg Mickey
Department of Medicine, University of Washington, Seattle, WA, USA.
Circulation. 2006 Dec 19;114(25):2760-5. doi: 10.1161/CIRCULATIONAHA.106.654715. Epub 2006 Dec 11.
The most recent resuscitation guidelines have sought to improve the interface between defibrillation and cardiopulmonary resuscitation; the survival impact of these changes is unknown, however. A year before issuance of the most recent guidelines, we implemented protocol changes that provided a single shock without rhythm reanalysis, stacked shocks, or postdefibrillation pulse check, and extended the period of cardiopulmonary resuscitation from 1 to 2 minutes. We hypothesized that survival would be better with the new protocol.
The present study took place in a community with a 2-tiered emergency medical services response and an established system of cardiac arrest surveillance, training, and review. The investigation was a cohort study of persons who had bystander-witnessed out-of-hospital ventricular fibrillation arrest because of heart disease, comparing a prospectively defined intervention group (January 1, 2005, to January 31, 2006) with a historical control group that was treated according to previous guidelines of rhythm reanalysis, stacked shocks, and postdefibrillation pulse checks (January 1, 2002, to December 31, 2004). The primary outcome was survival to hospital discharge. The proportion of treated arrests that met inclusion criteria was similar for intervention and control periods (15.4% [134/869] versus 16.6% [374/2255]). Survival to hospital discharge was significantly greater during the intervention period compared with the control period (46% [61/134] versus 33% [122/374], P=0.008) and corresponded to a decrease in the interval from shock to start of chest compressions (28 versus 7 seconds). Adjustment for covariates did not alter the survival association.
These results suggest the new resuscitation guidelines will alter the interface between defibrillation and cardiopulmonary resuscitation and in turn may improve outcomes.
最新的复苏指南致力于改善除颤与心肺复苏之间的衔接；然而，这些改变对生存率的影响尚不清楚。在发布最新指南的前一年，我们实施了方案变更，即单次除颤且不进行心律重新分析、不进行连续除颤或除颤后脉搏检查，并将心肺复苏时间从1分钟延长至2分钟。我们假设新方案能提高生存率。
本研究在一个具备两级紧急医疗服务响应以及完善的心脏骤停监测、培训和审查系统的社区开展。该调查是一项队列研究，比较了前瞻性定义的干预组（2005年1月1日至2006年1月31日）与按照先前心律重新分析、连续除颤和除颤后脉搏检查指南进行治疗的历史对照组（2002年1月1日至2004年12月31日），这些患者均为旁观者目击的因心脏病导致的院外心室颤动骤停。主要结局是存活至出院。干预期和对照期符合纳入标准的已治疗骤停比例相似（15.4%[134/869]对16.6%[374/2255]）。与对照期相比，干预期存活至出院的比例显著更高（46%[61/134]对33%[122/374]，P = 0.008），且这与从除颤到开始胸外按压的间隔时间缩短（28秒对7秒）相对应。对协变量进行调整并未改变生存关联。
这些结果表明新的复苏指南将改变除颤与心肺复苏之间的衔接，进而可能改善结局。
