院外心脏骤停复苏中团队式心肺复苏与标准心肺复苏的比较：一项全州质量改进计划的结果

Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.

作者信息

Pearson David A, Darrell Nelson R, Monk Lisa, Tyson Clark, Jollis James G, Granger Christopher B, Corbett Claire, Garvey Lee, Runyon Michael S

机构信息

Carolinas Medical Center, Charlotte, NC, United States.

Wake Forest University Health Sciences, Winston-Salem, NC, United States.

出版信息

Resuscitation. 2016 Aug;105:165-72. doi: 10.1016/j.resuscitation.2016.04.008. Epub 2016 Apr 27.

DOI:10.1016/j.resuscitation.2016.04.008

PMID:27131844

Abstract

BACKGROUND

Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown.

OBJECTIVES

To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR.

METHODS

This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1-2.

RESULTS

Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50-81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7-8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2-5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR feedback device (OR 0.47), and endotracheal intubation (OR 0.44) were associated with less likelihood for a good neurologic outcome.

CONCLUSION

In our statewide OHCA cohort, TFCPR was associated with improved survival with good neurological outcome.

摘要

背景

团队心肺复苏（TFCPR）是一种精心编排的心肺复苏方法，强调尽量减少中断高质量胸外按压、早期除颤，不鼓励气管插管，并鼓励使用袋阀面罩（BVM）和/或盲插气道装置（BIAD），通气频率为8 - 10次/分钟，以尽量减少过度通气。2011年开始在北卡罗来纳州（NC）的紧急医疗服务（EMS）机构广泛采用TFCPR，但其对结局的影响尚不清楚。

目的

确定与标准心肺复苏相比，TFCPR是否能提高院外心脏骤停（OHCA）患者获得良好神经功能结局的生存率。

方法

这项对2010年1月至2014年6月向增强生存心脏骤停登记处（CARES）数据库报告数据的NC EMS机构进行的回顾性队列分析，纳入了成年、非创伤性OHCA且病因推测为心脏性的患者，其中EMS进行了心肺复苏或患者接受了除颤。排除因EMS政策终止的心脏骤停或放弃心肺复苏（DNR）患者。EMS机构自行报告TFCPR实施日期。患者被分类为接受TFCPR或标准心肺复苏。主要结局是出院时良好的神经功能结局，定义为匹兹堡脑功能分类（CPC）1 - 2级。

结果

在14994例OHCA患者中，14129例患者纳入分析，平均年龄65岁（四分位间距50 - 81岁），男性占61%，7.3%有良好的神经功能结局，24.3%初始心律可除颤，71.5%接受TFCPR。在3427例（24.3%）初始心律可除颤的患者中，739例（71.9%）有良好的神经功能结局。TFCPR组的良好神经功能结局更高[836例（8.3%，95%置信区间7.7 - 8.8%）]，而标准心肺复苏组为[193例（4.8%，95%置信区间4.2 - 5.5%）]。控制人口统计学和心脏骤停特征的逻辑回归显示，TFCPR（比值比1.5）、目击心脏骤停（比值比4.3）、初始心律可除颤（比值比7.1）和院内低温（比值比3.3）与良好的神经功能结局相关。机械心肺复苏设备（比值比0.68）、心肺复苏反馈设备（比值比0.47）和气管插管（比值比0.44）与获得良好神经功能结局的可能性较小相关。