Chelsea and Westminster Hospital, London, UK.
Anaesthesia. 2013 Jul;68(7):694-9. doi: 10.1111/anae.12181. Epub 2013 May 27.
The importance of minimising aortocaval compression during cardiopulmonary resuscitation in late pregnancy is widely accepted. Current European guidelines suggest employing manual displacement of the uterus with left lateral tilt to achieve this. Several methods for producing lateral tilt have been described; however, the optimum method is unknown. By performing simulated cardiopulmonary resuscitation on a manikin, we compared four of these methods: a folded labour ward pillow; a pre-formed foam wedge; a custom-made hard wooden wedge; and the 'human wedge'. Primary outcome measures were maintenance of adequate tilt, stability and effectiveness of chest compressions (rate, depth and adequate release). Overall, the foam and wooden wedges were significantly more stable and reliable at maintaining tilt than the pillow (p<0.0001); the wooden wedge was more stable and effective than the foam wedge (p<0.0001). Chest compressions were least effective with the human wedge (p=0.02). Effectiveness of chest compressions with lateral tilt was comparable to that reported previously in supine manikin studies. We recommend the use of dedicated foam or hard wedges rather than pillows or the human wedge for producing lateral tilt during cardiopulmonary resuscitation.
在妊娠晚期进行心肺复苏时，尽量减少腹主动脉压迫的重要性已被广泛接受。目前的欧洲指南建议采用手动将子宫向左侧倾斜来实现这一目标。已经描述了几种产生侧倾的方法；然而，最佳方法尚不清楚。通过在模型上进行模拟心肺复苏，我们比较了这四种方法：折叠的产房枕头；预制的泡沫楔形物；定制的硬木楔形物；和“人体楔形物”。主要观察指标是维持足够的倾斜度、胸外按压的稳定性和有效性（频率、深度和充分释放）。总的来说，与枕头相比，泡沫和木制楔形物在维持倾斜方面明显更稳定和可靠（p<0.0001）；木制楔形物比泡沫楔形物更稳定和有效（p<0.0001）。使用人体楔形物时，胸外按压的效果最差（p=0.02）。使用侧向倾斜的胸外按压的有效性与之前仰卧模型研究中报道的相似。我们建议在心肺复苏期间使用专用的泡沫或硬楔形物来产生侧倾，而不是枕头或人体楔形物。
