Olsen Jan-Aage, Brunborg Cathrine, Steinberg Mikkel, Persse David, Sterz Fritz, Lozano Michael, Westfall Mark, Travis David T, Lerner E Brooke, Brouwer Marc A, Wik Lars
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
Resuscitation. 2015 Aug;93:158-63. doi: 10.1016/j.resuscitation.2015.04.023. Epub 2015 Apr 28.
Shorter manual chest compression pauses prior to defibrillation attempts is reported to improve the defibrillation success rate. Mechanical load-distributing band (LDB-) CPR enables shocks without compression pause. We studied pre-shock pause and termination of ventricular fibrillation/pulseless ventricular tachycardia 5s post-shock (TOF) and return of organized rhythm (ROOR) with LDB and manual (M-) CPR.
In a secondary analysis from the Circulation Improving Resuscitation Care trial, patients with initial shockable rhythm and interpretable post-shock rhythms were included. Pre-shock rhythm, pause duration (if any), and post-shock rhythm were obtained for each shock. Associations between TOF/ROOR and pre-shock pause duration, including no pause shocks with LDB-CPR, were analyzed with Chi-square test. A p-value <0.05 was considered statistically significant.
For TOF and ROOR analyses we included 417 LDB-CPR patients with 1476 and 1438 shocks, and 495 M-CPR patients with 1839 and 1796 shocks, respectively. For first shocks with LDB-CPR, pre-shock pause was associated with TOF (p=0.049) with lowest TOF (77%) for shocks given without pre-shock compression pause. This association was not significant when all shocks were included (p=0.07) and not for ROOR. With M-CPR there were no significant associations between shock-related chest compression pause duration and TOF or ROOR.
For first shocks with LDB-CPR, termination of fibrillation was associated with pre-shock pause duration. There was no association for the rate of return of organized rhythm. For M-CPR, where no shocks were given during continuous chest compressions, there were no associations between pre-shock pause duration and TOF or ROOR.
据报道，在尝试除颤之前缩短手动胸外按压停顿时间可提高除颤成功率。机械负荷分配带（LDB-）心肺复苏术可在无按压停顿的情况下进行电击。我们研究了LDB和手动（M-）心肺复苏术的电击前停顿以及电击后5秒心室颤动/无脉性室性心动过速的终止情况（TOF）和有组织节律的恢复情况（ROOR）。
在“改善复苏护理循环”试验的二次分析中，纳入了初始可电击心律且电击后心律可解释的患者。记录每次电击的电击前心律、停顿持续时间（如有）和电击后心律。采用卡方检验分析TOF/ROOR与电击前停顿持续时间之间的关联，包括LDB-CPR无停顿电击。p值<0.05被认为具有统计学意义。
对于TOF和ROOR分析，我们分别纳入了417例接受LDB-CPR的患者，共1476次和1438次电击，以及495例接受M-CPR的患者，共1839次和1796次电击。对于LDB-CPR的首次电击，电击前停顿与TOF相关（p=0.049），电击前无按压停顿的电击TOF最低（77%）。当纳入所有电击时，这种关联不显著（p=0.07），且与ROOR无关。对于M-CPR，电击相关的胸外按压停顿持续时间与TOF或ROOR之间无显著关联。
对于LDB-CPR的首次电击，颤动的终止与电击前停顿持续时间相关。有组织节律的恢复率无关联。对于M-CPR，在持续胸外按压期间不进行电击，电击前停顿持续时间与TOF或ROOR之间无关联。
