University of Otago, PO Box 7343, Wellington 6242, New Zealand.
Resuscitation. 2013 May;84(5):575-9. doi: 10.1016/j.resuscitation.2012.12.018. Epub 2013 Jan 18.
The pattern of interruptions to chest compressions in pre-hospital cardiac arrests in Wellington, New Zealand, was examined prospectively to determine whether the mode of defibrillation chosen by paramedics influenced interruptions, shock success and the return of spontaneous circulation (ROSC).
A prospective observational cohort study of 44 adult cardiac arrests in which 203 shocks were administered by Wellington Free Ambulance (WFA) paramedics was undertaken to compare Code-stat electronic records from Medtronic Lifepak 12 and Lifepak 15 defibrillators used in semi-automated (AED) or manual mode. Interruptions during the 30s prior to shock delivery as well as pre-shock and post-shock pauses were calculated. Shock success and ROSC were the outcome measures.
Pre-shock pauses were shorter in manual mode (median 3s, IQR 2-5) versus AED mode (median 4s, IQR 3-6; p=0.003). Interruptions of CPR in the 30s prior to shock delivery were also shorter in manual mode (median 7s, IQR 4-11) versus AED mode (median 14s, IQR 12-16; p=<0.001). Shock success rates and post-shock pauses were not statistically different between modes. ROSC was significantly higher in manual mode (18.49%) versus AED mode (8.33%, p=0.042).
When paramedics used the defibrillator in manual mode as compared to AED mode, interruptions to CPR during the 30s prior to shock delivery were significantly reduced and pre-shock pauses were also shorter. This was associated with increased ROSC. Manual defibrillation should be the preferred option for appropriately trained paramedics. Training in this locality has been changed accordingly.
本研究前瞻性地分析了新西兰惠灵顿院外心脏骤停患者中胸外按压中断的模式，以确定急救人员选择的除颤方式是否会影响中断、电击成功和自主循环恢复（ROSC）。
对惠灵顿急救中心（Wellington Free Ambulance，WFA）急救人员进行了 44 例成人心脏骤停的前瞻性观察队列研究，比较了使用 Medtronic Lifepak 12 和 Lifepak 15 除颤器的半自动（AED）或手动模式的 Code-stat 电子记录。计算了电击前 30s 内以及电击前和电击后暂停期间的中断时间。电击成功和 ROSC 是观察指标。
手动模式下的电击前暂停时间更短（中位数 3s，IQR 2-5），而 AED 模式下的电击前暂停时间更长（中位数 4s，IQR 3-6；p=0.003）。电击前 30s 内 CPR 中断时间在手动模式下也更短（中位数 7s，IQR 4-11），而在 AED 模式下更长（中位数 14s，IQR 12-16；p<0.001）。两种模式下的电击成功率和电击后暂停时间无统计学差异。手动模式下 ROSC 明显更高（18.49%），而 AED 模式下更低（8.33%，p=0.042）。
与 AED 模式相比，当急救人员使用手动除颤器时，电击前 30s 内 CPR 中断明显减少，电击前暂停时间也更短。这与 ROSC 增加有关。受过适当培训的急救人员应首选手动除颤。当地的培训已相应改变。
