双次序贯体外除颤治疗院外心搏骤停难治性心室颤动：系统评价和荟萃分析。
Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and meta-analysis.
机构信息
Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.
Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
出版信息
Resuscitation. 2019 Feb;135:124-129. doi: 10.1016/j.resuscitation.2018.10.025. Epub 2018 Oct 26.
BACKGROUND
Double sequential external defibrillation (DSED) is a novel intervention which has shown potential in the management of refractory ventricular fibrillation (VF). This review aims to identify the literature surrounding the use of DSED in out-of-hospital refractory VF and assess whether this intervention improves survival outcomes.
METHODS
The databases Ovid Medline, EMBASE, CINAHL, SCOPUS and the Cochrane Library were searched from their commencement to January 29th 2018. Google (scholar) was also searched for grey literature. We combined MeSH terms and text words for DSED in refractory VF and included studies that used an interventional or observational design. Study quality was assessed using the Newcastle-Ottawa Scale. A random effects model using the DerSimonian & Laird method was used to calculate pooled ORs and 95% CIs.
RESULTS
The search yielded 5351 unique records, of which two retrospective studies met the eligibility criteria. No randomised controlled trials were identified. The pooled population included 499 patients of which 19% (n = 95) received DSED and 81% (n = 404) were managed with standard resuscitation protocols. Confirmation of DSED was self-reported by paramedics. Neither study adjusted for confounding factors or baseline characteristics across the study groups. The definition of refractory VF and the protocol for DSED use differed across studies. Over half of cases were witnessed cardiac arrests (58.7%, n = 293) and bystander CPR was initiated in 53.3% (n = 266) of cases. In the meta-analysis, DSED had no effect on survival to hospital discharge (OR 0.69, 95% CI: 0.30, 1.60), event survival (OR 0.98, CI: 0.59, 1.62) or ROSC (OR 0.86, 95% CI: 0.49-1.48).
CONCLUSION
The effectiveness of DSED remains unclear. Further well-designed prospective studies are needed to determine whether DSED has a role in the treatment of refractory VF.
背景
双次序贯体外除颤（DSED）是一种新的干预措施，在治疗难治性心室颤动（VF）方面显示出了潜力。本综述旨在确定有关 DSED 在院外难治性 VF 中的应用文献，并评估该干预措施是否能改善生存结果。
方法
从 Ovid Medline、EMBASE、CINAHL、SCOPUS 和 Cochrane 图书馆的开始时间到 2018 年 1 月 29 日进行了数据库检索。还在 Google（学者）上搜索了灰色文献。我们将 DSED 在难治性 VF 中的 MeSH 术语和文本词相结合，并纳入了使用干预性或观察性设计的研究。使用纽卡斯尔-渥太华量表评估研究质量。使用 DerSimonian 和 Laird 方法的随机效应模型计算汇总 OR 和 95%CI。
结果
检索得到 5351 条独特的记录，其中两项回顾性研究符合入选标准。未发现随机对照试验。汇总人群包括 499 名患者，其中 19%（n=95）接受了 DSED，81%（n=404）接受了标准复苏方案。急救人员自行报告 DSED 的确认情况。两项研究都没有在研究组之间调整混杂因素或基线特征。难治性 VF 的定义和 DSED 使用方案在不同研究中有所不同。半数以上的病例为目击性心脏骤停（58.7%，n=293），53.3%（n=266）的病例开始了旁观者心肺复苏。在荟萃分析中，DSED 对出院存活率（OR 0.69，95%CI：0.30，1.60）、事件存活率（OR 0.98，CI：0.59，1.62）或 ROSC（OR 0.86，95%CI：0.49，1.48）没有影响。
结论
DSED 的有效性仍不清楚。需要进一步设计良好的前瞻性研究来确定 DSED 在难治性 VF 治疗中的作用。
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