不同心肺复苏按压-通气方法的有效性：系统评价。
Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review.
机构信息
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1W8, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1W8, Canada; Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy and Institute of Health Policy Management Evaluation, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.
出版信息
Resuscitation. 2017 Sep;118:112-125. doi: 10.1016/j.resuscitation.2017.05.032. Epub 2017 Jun 2.
AIM
To compare the effectiveness of different compression-to-ventilation methods during cardiopulmonary resuscitation (CPR) in patients with cardiac arrest.
METHODS
We searched MEDLINE and Cochrane Central Register of Controlled Trials from inception until January 2016. We included experimental, quasi-experimental, and observational studies that compared different chest compression-to-ventilation ratios during CPR for all patients and assessed at least one of the following outcomes: favourable neurological outcomes, survival, return of spontaneous circulation (ROSC), and quality of life. Two reviewers independently screened literature search results, abstracted data, and appraised the risk of bias. Random-effects meta-analyses were conducted separately for randomised and non-randomised studies, as well as study characteristics, such as CPR provider.
RESULTS
After screening 5703 titles and abstracts and 229 full-text articles, we included 41 studies, of which 13 were companion reports. For adults receiving bystander or dispatcher-instructed CPR, no significant differences were observed across all comparisons and outcomes. Significantly less adults receiving bystander-initiated or plus dispatcher-instructed compression-only CPR experienced favourable neurological outcomes, survival, and ROSC compared to CPR 30:2 (compression-to-ventilation) in un-adjusted analyses in a large cohort study. Evidence from emergency medical service (EMS) CPR providers showed significantly more adults receiving CPR 30:2 experiencing improved favourable neurological outcomes and survival versus those receiving CPR 15:2. Significantly more children receiving CPR 15:2 or 30:2 experienced favourable neurological outcomes, survival, and greater ROSC compared to compression-only CPR. However, for children <1 years of age, no significant differences were observed between CPR 15:2 or 30:2 and compression-only CPR.
CONCLUSIONS
Our results demonstrated that for adults, CPR 30:2 is associated with better survival and favourable neurological outcomes when compared to CPR 15:2. For children, more patients receiving CPR with either 15:2 or 30:2 compression-to ventilation ratio experienced favourable neurological function, survival, and ROSC when compared to CO-CPR for children of all ages, but for children <1years of age, no statistically significant differences were observed.
目的
比较心肺复苏（CPR）期间不同按压通气比在心脏骤停患者中的效果。
方法
我们检索了 MEDLINE 和 Cochrane 对照试验中心注册库，检索时间截至 2016 年 1 月。我们纳入了比较所有患者 CPR 期间不同按压通气比的实验、准实验和观察性研究，并评估了以下至少一项结果：有利的神经功能结局、存活率、自主循环恢复（ROSC）和生活质量。两位评审员独立筛选文献检索结果、提取数据并评估偏倚风险。对于随机和非随机研究以及 CPR 提供者等研究特征，分别进行了随机效应荟萃分析。
结果
在筛选了 5703 篇标题和摘要以及 229 篇全文文章后，我们纳入了 41 项研究，其中 13 项是伴随报告。对于接受旁观者或调度员指导的 CPR 的成年人，所有比较和结局均未观察到显著差异。在一项大型队列研究的未调整分析中，与 30:2（按压通气比）相比，接受旁观者启动或加调度员指导的单纯按压 CPR 的成年人经历有利的神经功能结局、存活率和 ROSC 的比例显著降低。来自急诊医疗服务（EMS）CPR 提供者的证据表明，与接受 15:2 相比，接受 30:2 的成年人经历改善的有利神经功能结局和存活率的比例显著增加。与单纯按压 CPR 相比，接受 15:2 或 30:2 的儿童经历有利的神经功能结局、存活率和更大的 ROSC 的比例显著增加。然而，对于 <1 岁的儿童，与单纯按压 CPR 相比，CPR 15:2 或 30:2 之间没有观察到显著差异。
结论
我们的结果表明，对于成年人，与 15:2 相比，CPR 30:2 与存活率和有利的神经功能结局相关。对于儿童，与 CO-CPR 相比，所有年龄段的儿童接受 15:2 或 30:2 按压通气比的患者经历有利的神经功能、存活率和 ROSC 的比例更高，但对于 <1 岁的儿童，没有观察到统计学上的显著差异。
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