Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA.
Resuscitation. 2018 Sep;130:182-188. doi: 10.1016/j.resuscitation.2018.05.005. Epub 2018 May 7.
To compare relative efficacy and safety of mechanical compression devices (AutoPulse and LUCAS) with manual compression in patients with cardiac arrest undergoing cardiopulmonary resuscitation (CPR).
For this Bayesian network meta-analysis, seven randomized controlled trials (RCTs) were selected using PubMed/Medline, EMBASE, and CENTRAL (Inception- 31 October 2017). For all the outcomes, median estimate of odds ratio (OR) from the posterior distribution with corresponding 95% credible interval (Cr I) was calculated. Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each intervention based on surface under the cumulative ranking curve (SUCRA).
In analysis of 12, 908 patients with cardiac arrest [AutoPulse (2, 608 patients); LUCAS (3, 308 patients) and manual compression (6, 992 patients)], manual compression improved survival at 30 days or hospital discharge (OR, 1.40, 95% Cr I, 1.09-1.94), and neurological recovery (OR, 1.51, 95% Cr I, 1.06-2.39) compared to AutoPulse. There were no differences between LUCAS and AutoPulse with regards to survival to hospital admission, neurological recovery or return of spontaneous circulation (ROSC). Manual compression reduced the risk of pneumothorax (OR, 0.56, 95% Cr I, 0.33-0.97); while, both manual compression (OR, 0.15, 95% Cr I, 0.01-0.73) and LUCAS (OR, 0.07, 95% Cr I, 0.00-0.43) reduced the risk of hematoma formation compared to AutoPulse. Probability analysis ranked manual compression as the most effective treatment for improving survival at 30 days or hospital discharge (SUCRA, 84%).
Manual compression is more effective than AutoPulse and comparable to LUCAS in improving survival at 30 days or hospital discharge and neurological recovery. Manual compression had lesser risk of pneumothorax or hematoma formation compared to AutoPulse.
比较机械压迫装置（AutoPulse 和 LUCAS）与心肺复苏（CPR）期间手动压迫在心脏骤停患者中的相对疗效和安全性。
对于这项贝叶斯网络荟萃分析，我们使用 PubMed/Medline、EMBASE 和 CENTRAL（起点-2017 年 10 月 31 日）选择了 7 项随机对照试验（RCT）。对于所有结局，我们从后验分布中计算中位数比值比（OR）的估计值及其相应的 95%可信区间（Cr I）。我们使用马尔可夫链蒙特卡罗（MCMC）建模来基于累积排序曲线下面积（SUCRA）估计每种干预措施的相对排名概率。
在对 12908 例心脏骤停患者的分析中[AutoPulse（2608 例）；LUCAS（3308 例）和手动压迫（6992 例）]，与 AutoPulse 相比，手动压迫可提高 30 天或出院时的存活率（OR，1.40，95%Cr I，1.09-1.94）和神经恢复（OR，1.51，95%Cr I，1.06-2.39）。与 AutoPulse 相比，LUCAS 与 AutoPulse 之间在入院存活率、神经恢复或自主循环恢复（ROSC）方面无差异。手动压迫降低气胸风险（OR，0.56，95%Cr I，0.33-0.97）；而手动压迫（OR，0.15，95%Cr I，0.01-0.73）和 LUCAS（OR，0.07，95%Cr I，0.00-0.43）降低 AutoPulse 形成血肿的风险。概率分析将手动压迫列为提高 30 天或出院时存活率的最有效治疗方法（SUCRA，84%）。
与 AutoPulse 相比，手动压迫在提高 30 天或出院时的存活率和神经恢复方面比 AutoPulse 更有效，且与 LUCAS 相当。与 AutoPulse 相比，手动压迫发生气胸或血肿的风险较小。
