Davis Daniel, Aguilar Steve A, Sell Rebecca, Minokadeh Anush, Husa Ruchika
Department of Emergency Medicine, University of California San Diego, San Diego, California.
Department of Emergency Medicine, Kaiser Permanente Medical Center, San Diego, California.
J Hosp Med. 2016 Apr;11(4):264-8. doi: 10.1002/jhm.2499. Epub 2015 Oct 28.
In cases of in-hospital-witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) arrest, it is unclear whether cardiopulmonary resuscitation prior to defibrillation attempt or expedited stacked defibrillation attempt is superior.
Retrospective, observational study of all admitted patients with continuous cardiac monitoring who suffered VF/VT arrest between July 2005 and June 2013. In the stacked shock period (2005-2008), institutional protocols advocated early defibrillation with administration of 3 stacked shocks with brief pauses between each single defibrillation attempt to confirm sustained VF/VT. During the initial chest compression period (2008-2011), the protocol was modified to perform a 2-minute period of chest compressions prior to each defibrillation, including the initial. In the modified stack shock period (2011-2013), for a monitored arrest, defibrillation attempts were expedited with up to 3 successive shocks administered for persistent VF/VT. In unmonitored arrest, chest compressions and ventilations were initiated prior to defibrillation. The primary outcome measure was survival to hospital discharge.
Six hundred sixty-one cardiopulmonary arrests were recorded during the study period, with 106 patients (16%) representing primary VF/VT. The incidence of VF/VT arrest did not vary significantly between the study periods (P= 0.16) Survival to hospital discharge for all primary VF/VT arrest victims decreased, then increased significantly from the stacked shock period to initial chest compression period to modified stacked shock period (58%, 18%, 71%, respectively, P < 0.01). Specific group differences were significant between the initial chest compression versus the stacked and modified stacked shock groups (all P < 0.01).
Data suggest that monitored VF/VT should undergo expeditious defibrillation with use of stacked shocks.
在院内目击的心室颤动/室性心动过速（VF/VT）骤停病例中，在尝试除颤前进行心肺复苏还是快速进行连续除颤尝试更为优越尚不清楚。
对2005年7月至2013年6月期间所有接受连续心脏监测且发生VF/VT骤停的住院患者进行回顾性观察研究。在连续电击期（2005 - 2008年），机构方案主张早期除颤，每次单独除颤尝试之间短暂停顿以确认持续的VF/VT，进行3次连续电击。在初始胸外按压期（2008 - 2011年），方案修改为在每次除颤前，包括首次除颤，进行2分钟的胸外按压。在改良连续电击期（2011 - 2013年），对于监测到的骤停，对持续的VF/VT快速进行多达3次连续电击尝试。在未监测到的骤停中，在除颤前开始胸外按压和通气。主要结局指标是出院存活。
研究期间记录了661次心肺骤停，其中106例患者（16%）为原发性VF/VT。VF/VT骤停的发生率在各研究期间无显著差异（P = 0.16）。所有原发性VF/VT骤停患者的出院存活率从连续电击期到初始胸外按压期再到改良连续电击期呈下降后显著上升趋势（分别为58%、18%、71%，P < 0.01）。初始胸外按压组与连续电击组和改良连续电击组之间的特定组间差异显著（均P < 0.01）。
数据表明，对于监测到的VF/VT应使用连续电击进行快速除颤。
