Adam Zulfiquar, Adam Safwaan, Khan Pia, Dunning Joel
Department of Cardiology, James Cook University Hospital, Middlesbrough, UK.
Interact Cardiovasc Thorac Surg. 2009 Jan;8(1):148-51. doi: 10.1510/icvts.2008.195974. Epub 2008 Oct 23.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 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. Patients who arrest after cardiac surgery and require chest reopening will have a period of no external chest compression and therefore, no cerebral or coronary perfusion. In addition, if a patient arrests prior to cardiac surgery there will be a period of time performing the sternotomy during which there will be no external compressions. We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.
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，在保护近期胸骨切开术时，或者在进行胸骨切开术且无法进行胸部按压的情况下，是否可以使用腹部心肺复苏术（CPR）来替代体外心脏按压。通过报告的检索共找到386篇论文，其中10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、出版日期和国家、所研究的患者群体、研究类型、相关结局和结果均列于表格中。心脏手术后发生心脏骤停且需要重新打开胸腔的患者，会有一段时间没有体外胸部按压，因此也没有脑灌注或冠状动脉灌注。此外，如果患者在心脏手术前发生心脏骤停，在进行胸骨切开术的一段时间内将没有体外按压。我们仅在一个猪模型中发现了一篇研究仅腹部CPR有效性的论文，尽管该论文确实表明腹部CPR实际上比胸部CPR效果好60%。对腹部和胸部交替按压的研究更为广泛，并且已证明其在自主循环恢复方面明显优于单纯胸部按压。我们得出结论，目前几乎没有证据支持仅腹部CPR，尽管这些研究可能支持这样一种观点，即它可能会潜在地增加冠状动脉和脑灌注压。
