Wang Chih-Hung, Tsai Min-Shan, Chang Wei-Tien, Huang Chien-Hua, Ma Matthew Huei-Ming, Chen Wen-Jone, Fang Cheng-Chung, Chen Shyr-Chyr, Lee Chien-Chang
1Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. 2Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin, Taiwan. 3Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan. 4Department of Epidemiology, Harvard School of Public Health, Boston, MA.
Crit Care Med. 2015 Apr;43(4):889-96. doi: 10.1097/CCM.0000000000000820.
Active compression-decompression resuscitation and impedance threshold device are proposed to improve survival of patients of cardiac arrest by lowering intrathoracic pressure and increasing cardiac output. The results of clinical studies of active compression-decompression resuscitation or impedance threshold device were controversial. This metaanalysis pooled results of randomized controlled trials to examine whether active compression-decompression resuscitation or impedance threshold device would improve outcomes of out-of-hospital cardiac arrest in comparison with standard cardiopulmonary resuscitation and to explore factors modifying these effects.
Medline and Embase were searched from inception to September 2013.
Randomized controlled trials comparing active compression-decompression resuscitation or impedance threshold device with standard cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients were selected. There were no restrictions for language, population, or publication year.
Data on study characteristics, including patients, intervention details, and outcome measures, were independently extracted.
Fifteen trials, including 16,088 patients, were identified from 331 potentially relevant references. Return of spontaneous circulation was designated as the primary outcome. The pooled result showed no significant improvement in return of spontaneous circulation by active compression-decompression resuscitation or impedance threshold device in comparison with standard cardiopulmonary resuscitation (risk ratio, 1.04; 95% CI, 0.93-1.16; I, 46%). There was also no significant difference in survival or neurologic outcome at hospital discharge between active compression-decompression resuscitation or impedance threshold device and standard cardiopulmonary resuscitation. The meta-regression indicated that this minimal effect might be modified by two important prognostic factors, that is, witnessed status and response time. After adjustment of these two factors, impedance threshold device appeared to improve return of spontaneous circulation, which could be further augmented by advanced airway use.
Active compression-decompression resuscitation or impedance threshold device seemed not to improve return of spontaneous circulation in out-of-hospital cardiac arrest patients. The meta-regression indicated two probable prognostic factors causing this minimal effect. Nonetheless, these findings referred to differences between trials and could not necessarily be extrapolated to individual patients. The individual patient-level extrapolation may need to be solved by a future randomized controlled trial.
主动按压-减压复苏术和阻抗阈值装置被认为可通过降低胸内压和增加心输出量来提高心脏骤停患者的生存率。主动按压-减压复苏术或阻抗阈值装置的临床研究结果存在争议。本荟萃分析汇总了随机对照试验的结果，以检验主动按压-减压复苏术或阻抗阈值装置与标准心肺复苏相比是否能改善院外心脏骤停的结局，并探索影响这些效果的因素。
检索了从创刊至2013年9月的Medline和Embase数据库。
选取了比较主动按压-减压复苏术或阻抗阈值装置与标准心肺复苏术用于院外心脏骤停患者的随机对照试验。对语言、研究对象或发表年份无限制。
独立提取有关研究特征的数据，包括患者、干预细节和结局指标。
从331篇可能相关的参考文献中识别出15项试验，共16088例患者。将自主循环恢复指定为主要结局。汇总结果显示，与标准心肺复苏相比，主动按压-减压复苏术或阻抗阈值装置在自主循环恢复方面无显著改善（风险比，1.04；95%可信区间，0.93 - 1.16；I²，46%）。主动按压-减压复苏术或阻抗阈值装置与标准心肺复苏术在出院时的生存率或神经学结局方面也无显著差异。荟萃回归表明，这一微小效应可能受两个重要的预后因素影响，即是否有旁观者目击和反应时间。调整这两个因素后，阻抗阈值装置似乎可改善自主循环恢复，使用高级气道可进一步增强这一效果。
主动按压-减压复苏术或阻抗阈值装置似乎不能改善院外心脏骤停患者的自主循环恢复。荟萃回归表明有两个可能导致这一微小效应的预后因素。尽管如此，这些发现指的是各试验之间的差异，不一定能外推至个体患者。个体患者层面的外推可能需要未来的随机对照试验来解决。
