院外心脏骤停的手动与半自动节律分析及除颤
Manual Versus Semiautomatic Rhythm Analysis and Defibrillation for Out-of-Hospital Cardiac Arrest.
作者信息
Nehme Ziad, Andrew Emily, Nair Resmi, Bernard Stephen, Smith Karen
机构信息
From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Jul;10(7). doi: 10.1161/CIRCOUTCOMES.116.003577.
BACKGROUND
Although manual and semiautomatic external defibrillation (SAED) are commonly used in the management of out-of-hospital cardiac arrest, the optimal strategy is not known. We hypothesized that SAED would reduce the time to first shock and lead to higher rates of cardioversion and survival compared with a manual strategy.
METHODS AND RESULTS
Between July 2005 and June 2015, we included adult out-of-hospital cardiac arrest of presumed cardiac pathogenesis. On October 2012, a treatment protocol using SAED was introduced after years of manual defibrillation. The effect of the SAED implementation on the time to first shock, successful cardioversion, and patient outcomes was assessed using interrupted time series regression adjusting for arrest factors and temporal trend. Of the 14 776 cases, 10 224 (69.2%) and 4552 (30.8%) occurred during the manual and SAED protocols, respectively. Although the proportion of patients shocked within 2 minutes of arrival increased during the SAED protocol for initial shockable rhythms (from 58.9% to 69.2%; <0.001), there was no difference in unadjusted rate of successful cardioversion after first shock (from 12.3% to 13.8%; =0.13). After adjustment, the odds of delivering the first shock within 2 minutes of arrival increased under the SAED protocol (adjusted odds ratio [AOR], 1.72; 95% confidence interval [CI], 1.32-2.26; <0.001). Despite this, the SAED protocol was associated with a reduction in survival to hospital discharge (AOR, 0.71; 95% CI, 0.55-0.92; =0.009), event survival (AOR, 0.74; 95% CI, 0.62-0.88; =0.001), and prehospital return of spontaneous circulation (AOR, 0.81; 95% CI, 0.68-0.96; =0.01) when compared with the manual protocol. There was also no improvement in the rate of successful cardioversion after first shock (AOR, 0.73; 95% CI, 0.51-1.06; =0.10).
CONCLUSIONS
Although SAED improved the time to first shock, this did not translate into higher rates of successful cardioversion or survival after out-of-hospital cardiac arrest. Advanced life support providers should be trained to use a manual defibrillation protocol.
背景
尽管手动体外除颤和半自动体外除颤（SAED）常用于院外心脏骤停的处理，但最佳策略尚不清楚。我们假设，与手动策略相比，SAED可缩短首次除颤时间，并提高复律和生存几率。
方法与结果
2005年7月至2015年6月期间，我们纳入了推测为心脏病因的成年院外心脏骤停患者。2012年10月，在多年使用手动除颤后引入了使用SAED的治疗方案。采用中断时间序列回归分析，对心脏骤停因素和时间趋势进行校正，评估实施SAED对首次除颤时间、成功复律及患者预后的影响。14776例病例中，分别有10224例（69.2%）和4552例（30.8%）发生在手动除颤方案和SAED方案实施期间。尽管在SAED方案实施期间，初始可除颤心律患者在到达后2分钟内接受除颤的比例有所增加（从58.9%增至69.2%；P<0.001），但首次除颤后成功复律的未校正率并无差异（从12.3%增至13.8%；P=0.13）。校正后，在SAED方案下，到达后2分钟内进行首次除颤的几率增加（校正优势比[AOR]为1.72；95%置信区间[CI]为1.32 - 2.26；P<0.001）。尽管如此，与手动方案相比，SAED方案与出院生存率降低（AOR为0.71；95%CI为0.55 - 0.92；P=0.009）、事件生存率降低（AOR为0.74；95%CI为0.62 - 0.88；P=0.001）及院外自主循环恢复率降低（AOR为0.81；95%CI为0.68 - 0.96；P=0.01）相关。首次除颤后成功复律的比率也未得到改善（AOR为0.73；95%CI为0.51 - 1.06；P=0.10）。
结论
尽管SAED缩短了首次除颤时间，但这并未转化为院外心脏骤停后更高的成功复律率或生存率。应培训高级生命支持人员使用手动除颤方案。
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