Theda Clark Regional Medical Center, Neenah, WI, USA.
Crit Care Med. 2013 Jul;41(7):1782-9. doi: 10.1097/CCM.0b013e31828a24e3.
The objective of this study was to conduct a meta-analysis of literature examining rates of return of spontaneous circulation from load-distributing band and piston-driven chest compression devices as compared with manual cardiopulmonary resuscitation.
Searches were conducted in MEDLINE, the ClinicalTrials.gov registry, and bibliographies on manufacturer websites for studies written in English.
Selection criteria for the meta-analysis required that studies must be human controlled (randomized, historical, or case-control) investigations with confirmed out-of-hospital cases.
A total of 12 studies (load-distributing band cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 8, piston-driven cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 4), comprising a total of 6,538 subjects with 1,824 return of spontaneous circulation events, met the selection criteria.
Random effects models were used to assess the relative effect of treatments on return of spontaneous circulation. Compared with manual cardiopulmonary resuscitation, load-distributing band cardiopulmonary resuscitation had significantly greater odds of return of spontaneous circulation (odds ratio, 1.62 [95% CI, 1.36, 1.92], p < 0.001). The treatment effect for piston-driven cardiopulmonary resuscitation was similar to manual cardiopulmonary resuscitation (odds ratio, 1.25 [95% CI, 0.92, 1.68];p = 0.151). The corresponding difference in percentages of return of spontaneous circulation rates from cardiopulmonary resuscitation was 8.3% for load-distributing band cardiopulmonary resuscitation and 5.2% for piston-driven cardiopulmonary resuscitation. Compared with manual cardiopulmonary resuscitation, combining both mechanical cardiopulmonary resuscitation devices produced a significant treatment effect in favor of higher odds of return of spontaneous circulation with mechanical cardiopulmonary resuscitation devices (odds ratio, 1.53 [95% CI, 1.32, 1.78], p < 0.001).
The ability to achieve return of spontaneous circulation with mechanical chest compression devices is significantly improved when compared with manual chest compressions. In the case of load-distributing band cardiopulmonary resuscitation, it was superior to manual cardiopulmonary resuscitation as the odds of return of spontaneous circulation were over 1.6 times greater. The robustness of these findings should be tested in large randomized clinical trials.
本研究旨在对考察自动充气式和活塞驱动式胸部按压设备与手动心肺复苏（CPR）相比，自主循环恢复（ROSC）率的文献进行荟萃分析。
在 MEDLINE、ClinicalTrials.gov 注册处以及制造商网站的参考文献中，以英文撰写的研究进行了检索。
荟萃分析的选择标准要求研究必须是人体对照（随机、历史或病例对照）研究，并确认是院外病例。
共有 12 项研究（自动充气式心肺复苏与手动心肺复苏的比较=8，活塞驱动式心肺复苏与手动心肺复苏的比较=4），共计 6538 名受试者，其中 1824 名发生自主循环恢复事件，符合选择标准。
使用随机效应模型评估治疗对自主循环恢复的相对效果。与手动心肺复苏相比，自动充气式心肺复苏具有更高的自主循环恢复几率（优势比，1.62 [95%置信区间，1.36，1.92]，p<0.001）。活塞驱动式心肺复苏的治疗效果与手动心肺复苏相似（优势比，1.25 [95%置信区间，0.92，1.68]；p=0.151）。自动充气式心肺复苏和活塞驱动式心肺复苏的自主循环恢复率的差异分别为 8.3%和 5.2%。与手动心肺复苏相比，联合使用两种机械心肺复苏设备可显著提高机械心肺复苏设备的自主循环恢复几率，具有治疗效果（优势比，1.53 [95%置信区间，1.32，1.78]，p<0.001）。
与手动胸部按压相比，机械胸部按压设备实现自主循环恢复的能力显著提高。在自动充气式心肺复苏的情况下，它优于手动心肺复苏，因为自主循环恢复的几率超过手动心肺复苏的 1.6 倍。这些发现的稳健性应在大型随机临床试验中进行检验。
