Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
Deceased Organ Donation, Canadian Blood Services, Ottawa, ON, Canada.
Crit Care Med. 2018 Mar;46(3):e268-e272. doi: 10.1097/CCM.0000000000002920.
There has been a growth in publications focusing on the phenomena of autoresuscitation in recent years. In 2010, we systematically reviewed the medical literature with the primary objective of summarizing the evidence on the timing of autoresuscitation. Healthcare professionals have continued to voice concerns regarding the potential for autoresuscitation. With this in mind, the objective of this brief report is to update the results of our original review of autoresuscitation.
We applied the same search strategy described in our original article to update our findings to include articles published from January 2009 to September 2016.
We screened an additional 1,859 citations, after duplicates were removed, and then assessed 46 full-text articles for eligibility, from which 15 studies were included for data extraction.
During the time period of this review, there have been 1) 10 additional adult and three pediatric case reports of autoresuscitation in patients after cessation of cardiopulmonary resuscitation; in those cases with continuous monitoring and confirmation of circulation, the longest events are reported to be 10 and 2 minutes, respectively for adults and children; 2) six adults (4%, total n = 162) with autoresuscitation events reported from two observational studies and one chart review of patients undergoing withdrawal of life-sustaining therapy; the longest time reported to be 89 seconds with electrocardiogram and invasive arterial blood pressure monitoring and 3 minutes with electrocardiogram monitoring only; 3) 12 pediatric patients studied with vital sign monitoring during withdrawal of life-sustaining therapy without any reports of autoresuscitation.
Although case reports of autoresuscitation are hampered by variability in observation and monitoring techniques, autoresuscitation has now been reported in adults and children, and there appears to be a distinction in timing between failed cardiopulmonary resuscitation and withdrawal of life-sustaining therapy. Although additional prospective studies are required to clarify the frequency and predisposing factors associated with this phenomenon, clinical decision-making regarding patient management under uncertainty is required nonetheless. Both adult and pediatric healthcare professionals should be aware of the possibility of autoresuscitation and monitor their patients accordingly before diagnosing death.
近年来，越来越多的出版物聚焦于自主复苏现象。2010 年，我们系统地回顾了医学文献，主要目的是总结自主复苏时机的证据。医疗保健专业人员继续对自主复苏的潜在风险表示担忧。考虑到这一点，本简要报告的目的是更新我们对自主复苏的原始综述结果。
我们应用了我们原始文章中描述的相同搜索策略来更新我们的发现，以包括 2009 年 1 月至 2016 年 9 月发表的文章。
在排除重复项后，我们筛选了另外 1859 条引文，然后评估了 46 篇全文文章的资格，其中 15 项研究被纳入数据提取。
在本次综述期间，出现了以下情况：1）10 例成人和 3 例儿科心肺复苏停止后自主复苏的病例报告；在那些进行连续监测并确认循环的情况下，最长的事件分别为成人和儿童的 10 分钟和 2 分钟；2）两项观察性研究和一项生命支持治疗撤回的病历回顾报告了 6 例成人（4%，总 n=162）自主复苏事件；报告的最长时间为心电图和有创动脉血压监测的 89 秒和仅心电图监测的 3 分钟；3）12 例儿科患者在生命支持治疗撤回期间进行生命体征监测，无自主复苏报告。
尽管自主复苏的病例报告受到观察和监测技术的变异性的限制，但现在已经在成人和儿童中报告了自主复苏，并且心肺复苏失败和生命支持治疗撤回之间似乎存在时间上的区别。尽管需要进一步的前瞻性研究来阐明与这种现象相关的频率和易患因素，但仍需要在不确定的情况下对患者管理做出临床决策。成人和儿科医疗保健专业人员都应该意识到自主复苏的可能性，并在诊断死亡之前相应地监测他们的患者。
