Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia.
Emerg Med J. 2012 Oct;29(10):826-9. doi: 10.1136/emermed-2011-200080. Epub 2011 Nov 22.
Many studies over the past decade have investigated delaying initial defibrillation to perform cardiopulmonary resuscitation (CPR), as it has been associated with increased rates of restoration of spontaneous circulation and/or survival. Since 2006, a number of studies have investigated these procedures. The objective of this study was to undertake a literature review examining the commencement of CPR before defibrillation in the out-of-hospital setting.
A literature review was undertaken using the electronic medical databases Ovid Medline, EMBASE, CINHAL Plus, Cochrane Systematic Review and Meditext, from their commencement to the end of June 2011. Keywords used in the search included: CPR, defibrillation, ventricular fibrillation, VF, EMS, EMT, paramedic, emergency medical service, emergency medical technician, prehospital, out-of-hospital and ambulance. References of relevant articles were also reviewed.
Of the 3079 articles located, 10 met the inclusion criteria. The results of these studies showed conflicting results. All retrospective studies (n=6) indicated a benefit in performing pre-shock CPR on patients with ventricular fibrillation for durations between 90 and 180 s. Conversely, all randomised controlled trials demonstrated no benefit from providing CPR before defibrillation compared with immediate defibrillation for return of spontaneous circulation, neurological outcome and/or survival to hospital discharge. However, none of the studies reported evidence that CPR before defibrillation is harmful.
Conflicting evidence remains regarding the benefit of CPR before defibrillation. The establishment of a consistent timeframe of chest compressions before defibrillation in the out-of-hospital setting will provide uniformity in standards in clinical practice and education and training.
过去十年的许多研究都调查了延迟初始除颤以进行心肺复苏（CPR），因为它与自发循环恢复率和/或存活率的提高有关。自 2006 年以来，已经有许多研究调查了这些程序。本研究的目的是进行文献综述，检查院外环境中除颤前开始 CPR。
使用电子医学数据库 Ovid Medline、EMBASE、CINHAL Plus、Cochrane 系统评价和 Meditext，从开始到 2011 年 6 月底进行文献回顾。搜索中使用的关键词包括：CPR、除颤、心室颤动、VF、EMS、EMT、护理人员、急救医疗服务、急救医疗技术员、院前、院外和救护车。还审查了相关文章的参考文献。
在 3079 篇文章中，有 10 篇符合纳入标准。这些研究的结果显示出相互矛盾的结果。所有回顾性研究（n=6）均表明，对心室颤动患者进行 90 至 180 秒的预冲击 CPR 有益。相反，所有随机对照试验都表明，与立即除颤相比，在除颤前提供 CPR 并不能提高自发循环恢复、神经功能结果和/或存活至出院的效果。然而，没有一项研究报告证据表明在除颤前进行 CPR 是有害的。
关于在除颤前进行 CPR 的益处，仍然存在相互矛盾的证据。在院外环境中建立一致的胸外按压时间框架，将为临床实践和教育培训中的标准提供一致性。
