Tsagkataki Myrto, Levine Adrian, Strang Tim, Dunning Joel
Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
Interact Cardiovasc Thorac Surg. 2008 May;7(3):457-62. doi: 10.1510/icvts.2007.171447. Epub 2008 Feb 6.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether adrenaline might be a useful addition to a protocol for the management of cardiac arrests for patients shortly after cardiac surgery. Altogether 889 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The quality and level of evidence was assessed using the International Liaison Committee on Resuscitation guideline recommendations. We conclude that the European Resuscitation Council and the American Heart Association both recommend 1 mg of adrenaline as soon as pulseless electrical activity or asystole is identified or after the second failed shock if the rhythm is VF/pulseless VT. However, they acknowledge that the evidence behind this recommendation is lacking and based entirely on animal studies which have as yet not been successfully replicated in human studies to show a benefit of survival to hospital discharge. They acknowledge that the current evidence is insufficient to support or refute the use of adrenaline in arrests and the International Liaison Committee on Resuscitation grade the recommendation to give adrenaline in cardiac arrests as 'indeterminate'. Thus, in the particular situation of a patient who arrests shortly after cardiac surgery where the chance of restoring sinus rhythm either by defibrillation or by an emergency re-sternotomy is high, and where adrenaline could in this situation be highly dangerous once sinus rhythm is restored, we recommend that 1 mg of adrenaline forms no part of the resuscitation protocol for patients who arrest after cardiac surgery.
一篇心脏外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是，对于心脏手术后不久的患者，在心脏骤停管理方案中添加肾上腺素是否有用。通过报告的检索共找到889篇论文，其中16篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期、国家、研究的患者群体、研究类型、相关结果和结果均列于表格中。使用国际复苏联合委员会的指南建议评估证据的质量和级别。我们得出结论，欧洲复苏委员会和美国心脏协会均建议，一旦识别出无脉电活动或心脏停搏，或在第二次除颤失败后（如果心律为室颤/无脉性室速）立即给予1毫克肾上腺素。然而，他们承认该建议背后的证据不足，完全基于动物研究，而这些研究尚未在人体研究中成功复现以显示对出院存活有益。他们承认目前的证据不足以支持或反驳在心脏骤停时使用肾上腺素，国际复苏联合委员会将在心脏骤停时给予肾上腺素的建议评为“不确定”。因此，在心脏手术后不久发生心脏骤停的特定情况下，通过除颤或紧急再次开胸恢复窦性心律的机会很高，且在这种情况下一旦恢复窦性心律肾上腺素可能非常危险，我们建议1毫克肾上腺素不应成为心脏手术后心脏骤停患者复苏方案的一部分。
