University of Toronto, Toronto, ON, Canada.
Circulation. 2011 Jul 5;124(1):58-66. doi: 10.1161/CIRCULATIONAHA.110.010736. Epub 2011 Jun 20.
Perishock pauses are pauses in chest compressions before and after defibrillatory shock. We examined the relationship between perishock pauses and survival to hospital discharge.
We included out-of-hospital cardiac arrest patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia), and had cardiopulmonary resuscitation process data for at least 1 shock (n=815). We used multivariable logistic regression to determine the association between survival and perishock pauses. In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with preshock pause ≥20 seconds (odds ratio, 0.47; 95% confidence interval, 0.27 to 0.82) and perishock pause ≥40 seconds (odds ratio, 0.54; 95% confidence interval, 0.31 to 0.97) compared with patients with preshock pause <10 seconds and perishock pause <20 seconds. Postshock pause was not independently associated with a significant change in the odds of survival. Log-linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5-second increase in both preshock and perishock pause interval (up to 40 and 50 seconds, respectively), with no significant association noted with changes in the postshock pause interval.
In patients with cardiac arrest presenting in a shockable rhythm, longer perishock and preshock pauses were independently associated with a decrease in survival to hospital discharge. The impact of preshock pause on survival suggests that refinement of automatic defibrillator software and paramedic education to minimize preshock pause delays may have a significant impact on survival.
电击前暂停和电击后暂停是指在进行除颤电击之前和之后的胸外按压暂停。我们研究了电击前暂停与存活至出院的关系。
我们纳入了复苏结果联合会 Epistry-Cardiac Arrest 中的院外心脏骤停患者，这些患者在 2005 年 12 月至 2007 年 6 月期间发生心脏骤停，表现为可电击节律（心室颤动或无脉性室性心动过速），并且至少有 1 次电击的心肺复苏过程数据（n=815）。我们使用多变量逻辑回归来确定存活与电击前暂停之间的关系。在调整了生存的 Utstein 预测因素的分析中，与电击前暂停<10 秒和电击前暂停<20 秒的患者相比，电击前暂停≥20 秒（优势比，0.47；95%置信区间，0.27 至 0.82）和电击前暂停≥40 秒（优势比，0.54；95%置信区间，0.31 至 0.97）的患者存活的可能性显著降低。电击后暂停与存活的几率没有显著相关。对数线性建模显示，电击前和电击暂停时间每增加 5 秒，存活至出院的几率分别下降 18%和 14%（分别高达 40 秒和 50 秒），而与电击后暂停时间的变化没有显著关联。
在表现为可电击节律的心脏骤停患者中，电击前和电击暂停时间较长与存活至出院的几率降低独立相关。电击前暂停对存活的影响表明，对自动除颤器软件进行细化并对护理人员进行教育以尽量减少电击前暂停时间的延迟，可能会对存活产生重大影响。
