Ross Elliot M, Redman Theodore T, Harper Stephen A, Mapp Julian G, Wampler David A, Miramontes David A
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA.
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA.
Resuscitation. 2016 Sep;106:14-7. doi: 10.1016/j.resuscitation.2016.06.011. Epub 2016 Jun 21.
The goal of our study is to determine if prehospital dual defibrillation (DD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest.
This study is a retrospective cohort analysis of prospectively collected Quality Assurance/Quality Improvement data from a large urban fire based EMS system out-of-hospital cardiac arrest (OHCA) database between Jan 2013 and Dec 2015. Our inclusion criteria were administration of DD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF). We excluded any case with incomplete data. The primary outcome for our study was neurologically intact survival (defined as Cerebral Performance Category 1 and 2).
A total of 3470 cases of OHCA were treated during the time period of Jan 2013 to Dec 2015. There were 302 cases of recurrent and refractory VF identified. Twenty-three cases had incomplete data. Of the remaining 279 cases, 50 were treated with DD and 229 received standard single shock 200J defibrillations. There was no statistically significant difference in the primary outcome of neurologically intact survival between the DD group (6%) and the standard defibrillation group (11.4%) (p=0.317) (OR 0.50, 95% CI 0.15-1.72).
Our retrospective cohort analysis on the prehospital use of DD in OHCA found no association with neurologically intact survival. Case-control studies are needed to further evaluate the efficacy of DD in the prehospital setting.
我们研究的目的是确定院外心脏骤停时院前双相除颤（DD）是否与更好的神经功能完好存活相关。
本研究是一项回顾性队列分析，对2013年1月至2015年12月期间从一个大型城市基于消防的急救医疗服务系统院外心脏骤停（OHCA）数据库中前瞻性收集的质量保证/质量改进数据进行分析。我们的纳入标准是对复发性和难治性室颤（VF）病例进行双相除颤或至少四次常规200J除颤。我们排除了任何数据不完整的病例。我们研究的主要结局是神经功能完好存活（定义为脑功能分级1级和2级）。
在2013年1月至2015年12月期间共治疗了3470例院外心脏骤停病例。确定了302例复发性和难治性室颤病例。23例数据不完整。在其余279例中，50例接受了双相除颤治疗，229例接受了标准的单次200J除颤。双相除颤组（6%）和标准除颤组（11.4%）在神经功能完好存活这一主要结局上无统计学显著差异（p = 0.317）（OR 0.50，95% CI 0.15 - 1.72）。
我们对院外心脏骤停时院前使用双相除颤的回顾性队列分析发现其与神经功能完好存活无关。需要进行病例对照研究以进一步评估双相除颤在院前环境中的疗效。
