Skogvoll Eirik, Nordseth Trond
Department of Anaesthesiology and Emergency Medicine, St. Olav University Hospital, Trondheim, Norway.
Scand J Trauma Resusc Emerg Med. 2008 Sep 22;16:11. doi: 10.1186/1757-7241-16-11.
In the early minutes of cardiac arrest, timing of defibrillation and cardiopulmonary resuscitation during the basic life support phase (BLS CPR) is debated. Aims of this study were to provide in-hospital incidence and outcome data, and to investigate the relation between outcome and time from collapse to defibrillation, time to BLS CPR, and CPR quality.
Resuscitation attempts during a 3-year period at St. Olav's University Hospital (960 beds) were prospectively registered. The times between collapse and initiation of BLS CPR, and defibrillation were determined. CPR quality was assessed by the resuscitation team. The relation between these variables and outcome (short term survival and discharge) was explored using non-parametric correlation and logistic regression.
CPR was started in a total of 223 arrests, an incidence of 77 episodes per 1000 beds per year. Return of spontaneous circulation occurred in 40%, and 29 patients (13%) survived to discharge. Median time from collapse to BLS CPR was 1 minute; CPR was judged to be of good quality in half of the episodes. CPR during the first 3 minutes in ventricular fibrillation (VF/VT) was negatively associated with survival, but later proved beneficial. For patients with non-shockable rhythms, we found no association between outcome and time to BLS or CPR quality.
Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality.
在心脏骤停后的最初几分钟内，基础生命支持阶段（BLS CPR）中除颤和心肺复苏的时机存在争议。本研究的目的是提供院内发病率和结局数据，并调查从心脏骤停至除颤的时间、开始BLS CPR的时间以及心肺复苏质量与结局之间的关系。
前瞻性登记了圣奥拉夫大学医院（960张床位）3年内的复苏尝试情况。确定了从心脏骤停至开始BLS CPR以及除颤之间的时间。复苏团队评估了心肺复苏质量。使用非参数相关性和逻辑回归探讨了这些变量与结局（短期生存和出院）之间的关系。
总共对223例心脏骤停患者进行了心肺复苏，发病率为每年每1000张床位77例。40%的患者恢复了自主循环，29例患者（13%）存活至出院。从心脏骤停至开始BLS CPR的中位时间为1分钟；一半的病例中，心肺复苏被判定质量良好。心室颤动（VF/VT）发生后的前3分钟内进行心肺复苏与生存呈负相关，但后来证明是有益的。对于不可电击心律的患者，我们发现结局与开始BLS的时间或心肺复苏质量之间没有关联。
我们的研究结果表明，在VF/VT的前3分钟内，除颤应优先进行。之后，患者可从心肺复苏与除颤相结合中获益。出现不可电击心律的患者预后严重，结局与开始BLS的时间或心肺复苏质量无关。
