Cheskes Sheldon, Hillier Morgan, Byers Adam, Verbeek P Richard, Drennan Ian R, Zhan Cathy, Morrison Laurie J
Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; University of Toronto, Department of Family and Community Medicine, Division of Emergency Medicine, Toronto, ON, Canada; Rescu Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.
University of Toronto, Department of Medicine, Toronto, ON, Canada.
Resuscitation. 2015 May;90:61-6. doi: 10.1016/j.resuscitation.2015.02.022. Epub 2015 Feb 28.
Pre-shock pause duration of <20s is associated with improved survival after cardiac arrest. Manual mode defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by advanced life support paramedics (ALS) whereas defibrillator only paramedics (basic life support or BLS) routinely use the defibrillator in automatic mode.
We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and rate of inappropriate shocks when defibrillation is provided by ALS vs. BLS trained in manual mode defibrillation.
We performed a retrospective review of all treated non-traumatic adult out-of-hospital cardiac arrest (OHCA) presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by BLS with pre-shock pause duration of <20s when compared to ALS. Our secondary outcome measures were the duration of pre-, post- and peri-shock pause and the proportion of appropriate shocks (defined as correct identification and shock delivery to patients in a shockable rhythm) delivered by either level of paramedic. This study had a power of 90% to detect an absolute difference of 15% between paramedic levels in proportion of shocks delivered with pre-shock pause duration <20s.
Among 2019 treated OHCA, 335 (20%) presented in a shockable rhythm. Manual defibrillation was performed in 155 (46%) of these cases (196 shocks by ALS, 143 shocks by BLS). There were no differences in the proportion of shocks delivered with pre-shock pause duration <20s (ALS 82.8% vs. BLS 84.8%, p=.65) nor pre-shock pause duration (s) (median, Q1, Q3); ALS: 12.0 (7.0,17.0) vs. BLS: 11.0 (5.0,17.0), p=.13 while BLS had a significantly shorter peri-shock pause duration (s) (median, Q1, Q3); ALS: 17.0 (12.0, 23.0) vs. BLS: 15.0 (9.0, 22.0), p=.05. There were no differences in the rate of inappropriate shocks (ALS 1.0% vs. BLS 0.7%), p=1.0 between levels of paramedics.
Manual mode defibrillation by BLS paramedics produced similar measures of pre-shock pause duration when compared to ALS paramedics without increasing the incidence of inappropriate shocks. Further study is required to determine the potential impact of BLS manual mode defibrillation on clinical outcomes.
心脏骤停后，预电击停顿时间<20秒与生存率提高相关。手动模式除颤与最短的预电击停顿时间相关，但主要由高级生命支持护理人员（ALS）实施，而仅使用除颤器的护理人员（基础生命支持或BLS）通常以自动模式使用除颤器。
我们试图探讨在接受手动模式除颤培训的ALS与BLS进行除颤时，手动模式除颤、预电击停顿时间和不适当电击率之间的关系。
我们对2012年1月1日开始的一年期间所有以可电击心律就诊的非创伤性成人院外心脏骤停（OHCA）病例进行了回顾性研究。我们的主要结局指标是与ALS相比，BLS进行的手动模式电击且预电击停顿时间<20秒的比例。我们的次要结局指标是预电击、后电击和电击周围停顿的持续时间，以及两种护理人员级别进行的适当电击（定义为正确识别并对可电击心律的患者进行电击）的比例。本研究有90%的把握度检测出护理人员级别之间在预电击停顿时间<20秒的电击比例上15%的绝对差异。
在2019例接受治疗的OHCA中，335例（20%）呈现可电击心律。其中155例（46%）进行了手动除颤（ALS进行196次电击，BLS进行143次电击）。预电击停顿时间<20秒的电击比例（ALS为82.8%，BLS为84.8%，p = 0.65）以及预电击停顿时间（秒）（中位数、第一四分位数、第三四分位数）无差异；ALS：12.0（7.0，17.0），BLS：11.0（5.0，17.0），p = 0.13，而BLS的电击周围停顿时间（秒）（中位数、第一四分位数、第三四分位数）明显更短；ALS：17.0（12.0，23.0），BLS：15.0（9.0，22.0），p = 0.05。护理人员级别之间不适当电击率无差异（ALS为1.0%，BLS为0.7%），p = 1.0。
与ALS护理人员相比，BLS护理人员进行的手动模式除颤产生的预电击停顿时间测量结果相似，且未增加不适当电击的发生率。需要进一步研究以确定BLS手动模式除颤对临床结局的潜在影响。
