Physio-Control, Lund, Sweden.
Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
Resuscitation. 2017 Jun;115:155-162. doi: 10.1016/j.resuscitation.2017.04.005. Epub 2017 Apr 4.
The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it.
Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients.
Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p=0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p=0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P<0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group.
No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.
LINC 试验评估了两种用于 OHCA 患者的 ALS-CPR 算法，包括 3 分钟的机械胸部按压（LUCAS）循环，带有除颤尝试通过按压与 2 分钟的手动按压，带有按压暂停以进行除颤。PARAMEDIC 试验使用 2 分钟的算法发现，在 LUCAS 组中，初始 VF/VT 的患者的结果更差，并且与手动组相比，他们接受了更多的肾上腺素。我们想评估这些算法对初始除颤后仍处于 VF/VT 的患者是否有任何结果影响，以及肾上腺素的时机如何影响它。
两组患者均先接受手动胸部按压。根据非电子 CPR 过程文件，对初始除颤后仍为 VF/VT 的患者进行结局、神经状态及其与首次自发循环恢复（ROSC）前 CPR 持续时间的关系、除颤时间和给予肾上腺素的分析。VF/VT 患者亚组。
初始胸部按压结合除颤尝试（374 例接受机械 CPR）或未进行除颤（383 例接受手动 CPR）后，757 例患者仍为 VF/VT。ROSC 无差异（机械 CPR 58.3%比手动 CPR 58.6%，p=0.94）或 6 个月生存率良好的神经功能结局（机械 CPR 25.1%比手动 CPR 23.0%，p=0.50）。从手动胸部按压开始到首次除颤的时间有显著差异（机械 CPR：4（2-5）分钟比手动 CPR 3（2-4）分钟，P<0.001）。机械 CPR 组从开始手动胸部按压到 ROSC 的时间较长。
在初始除颤后仍为 VF/VT 的患者中，两种算法在短期和长期结局方面无差异。机械 CPR 组首次除颤时间和除颤间隔时间较长，但对总体结局无影响。两组达到 ROSC 所需的除颤次数或肾上腺素剂量无差异。
