Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Circ Arrhythm Electrophysiol. 2010 Feb;3(1):72-8. doi: 10.1161/CIRCEP.109.902114. Epub 2009 Dec 30.
Unlike Resuscitation Guidelines (GL) 2000, GL2005 advise resuming cardiopulmonary resuscitation (CPR) immediately after defibrillation. We hypothesized that immediate CPR resumption promotes earlier recurrence of ventricular fibrillation (VF).
This study used data of a prospective per-patient randomized controlled trial. Automated external defibrillators used by first responders were randomized to either (1) perform postshock analysis and prompt rescuers to a pulse check (GL2000), or (2) resume CPR immediately after defibrillation (GL2005). Continuous recordings of ECG and impedance signals were collected from all patients with an out-of-hospital cardiac arrest to whom a randomized automated external defibrillator was applied. We included patients with VF as their initial rhythm in whom CPR onset could be determined from the ECG and impedance signals. Time intervals are presented as median (Q1-to-Q3). Of 361 patients, 136 met the inclusion criteria: 68 were randomly assigned to GL2000 and 68 to GL2005. Rescuers resumed CPR 30 (21-to-39) and 8 (7-to-9) seconds, respectively, after the first shock that successfully terminated VF (P<0.001); VF recurred after 40 (21-to-76) and 21 (10-to-80) seconds, respectively (P=0.001). The time interval between start of CPR and VF recurrence was 6 (0-to-67) and 8 (3-to-61) seconds, respectively (P=0.88). The hazard ratio for VF recurrence in the first 2 seconds of CPR was 15.5 (95% confidence interval, 5.63 to 57.7) compared with before CPR resumption. After more than 8 seconds of CPR, the hazard of VF recurrence was similar to before CPR resumption.
Early CPR resumption after defibrillation causes early VF recurrence. Clinical Trial Registration- clinicaltrials.gov Identifier: ISRCTN72257677.
与 2000 年复苏指南（GL）不同，2005 年 GL 建议在除颤后立即恢复心肺复苏（CPR）。我们假设立即恢复 CPR 可促进室颤（VF）更早复发。
本研究使用了一项前瞻性逐例随机对照试验的数据。第一响应者使用的自动体外除颤器被随机分配至（1）进行除颤后分析并提示急救人员进行脉搏检查（GL2000），或（2）在除颤后立即恢复 CPR（GL2005）。对所有接受随机自动体外除颤器治疗的院外心脏骤停患者连续记录心电图和阻抗信号。我们纳入了初始节律为 VF 的患者，可根据心电图和阻抗信号确定 CPR 开始时间。时间间隔以中位数（Q1 到 Q3）表示。在 361 名患者中，有 136 名符合纳入标准：68 名被随机分配至 GL2000 组，68 名被随机分配至 GL2005 组。在首次成功终止 VF 的电击后，急救人员分别在 30（21 到 39）秒和 8（7 到 9）秒后恢复 CPR（P<0.001）；VF 在电击后分别在 40（21 到 76）秒和 21（10 到 80）秒后再次发生（P=0.001）。CPR 开始至 VF 复发的时间间隔分别为 6（0 到 67）秒和 8（3 到 61）秒（P=0.88）。在 CPR 恢复前的 2 秒内，VF 复发的危险比为 15.5（95%置信区间，5.63 至 57.7）。在 CPR 开始后超过 8 秒，VF 复发的危险与 CPR 恢复前相似。
除颤后早期恢复 CPR 会导致 VF 早期复发。临床试验注册-ClinicalTrials.gov 标识符：ISRCTN72257677。
