Sanna Tommaso, La Torre Giuseppe, de Waure Chiara, Scapigliati Andrea, Ricciardi Walter, Dello Russo Antonio, Pelargonio Gemma, Casella Michela, Bellocci Fulvio
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Resuscitation. 2008 Feb;76(2):226-32. doi: 10.1016/j.resuscitation.2007.08.001. Epub 2007 Sep 17.
Out-of-hospital cardiac arrest (OHCA) accounts for 250.000-350.000 sudden cardiac deaths per year in the United States. The availability of automated external defibrillators (AEDs) promoted the implementation of public access defibrillation programs based on out-of-hospital early defibrillation by non-healthcare professionals.
To perform a systematic review and a meta-analysis of the pooled effect of studies comparing the outcome of pts receiving cardiopulmonary resuscitation plus AED therapy (CPR+AED) vs. cardiopulmonary resuscitation (CPR) alone, both delivered by non-healthcare professionals, for the treatment of OHCA.
We performed a search of the relevant literature exploring major scientific databases, carrying out a hand search of key journals, analysing conference proceedings and abstracts and discussing the topic with other researchers. Two analyses were planned to assess the outcomes of interest (survival to hospital admission and survival to hospital discharge).
Three studies were selected for the meta-analysis. The first meta-analysis evidenced a RR of 1.22 (95% C.I.: 1.04-1.43) of surviving to hospital admission for people treated with CPR+AED as compared to CPR-only. The second meta-analysis showed a RR of 1.39 (95% C.I.: 1.06-1.83) of surviving to hospital discharge for people treated with CPR+AED as compared to CPR-only.
The results of our meta-analysis demonstrate that programs based on CPR plus early defibrillation with AEDs by trained non-healthcare professionals offer a survival advantage over CPR-only in OHCA. The conclusions of our meta-analysis add to previous evidence in favour of developing public-health strategies based on AED use by trained layrescuers.
在美国，院外心脏骤停（OHCA）每年导致25万至35万例心源性猝死。自动体外除颤器（AED）的普及推动了基于非医疗专业人员进行院外早期除颤的公众可获取除颤计划的实施。
对比较接受心肺复苏加AED治疗（CPR+AED）与单纯心肺复苏（CPR）的患者结局的研究汇总效应进行系统评价和荟萃分析，这两种治疗均由非医疗专业人员实施，用于治疗OHCA。
我们检索了相关文献，探索了主要科学数据库，对手持关键期刊进行了手工检索，分析了会议论文集和摘要，并与其他研究人员讨论了该主题。计划进行两项分析以评估感兴趣的结局（入院存活和出院存活）。
三项研究被选入荟萃分析。第一次荟萃分析表明，与仅接受CPR的患者相比，接受CPR+AED治疗的患者入院存活的相对危险度（RR）为1.22（95%可信区间：1.04-1.43）。第二次荟萃分析显示，与仅接受CPR的患者相比，接受CPR+AED治疗的患者出院存活的RR为1.39（95%可信区间：1.06-1.83）。
我们的荟萃分析结果表明，由经过培训的非医疗专业人员实施的基于CPR加早期AED除颤的计划在OHCA中比单纯CPR具有生存优势。我们的荟萃分析结论补充了先前支持制定基于训练有素的非专业救援人员使用AED的公共卫生策略的证据。
