Thomas Matthew, Voss Sarah, Benger Jonathan, Kirby Kim, Nolan Jerry P
Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust Bristol Royal Infirmary, Bristol, BS2 8HW, England.
Department of Emergency Care, University of West of England Glenside Campus (1H14), Blackberry Hill, Bristol, BS16 1DD, England.
BMC Emerg Med. 2019 Jan 25;19(1):16. doi: 10.1186/s12873-018-0214-1.
Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment.
A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention.
One hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90 days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients.
It may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research.
ISRCTN 49548506 retrospectively registered on 24.11.2016.
院外心脏骤停（OHCA）后的高氧血症与不良预后相关。动物数据表明复苏后的第一个小时可能最为关键。在英国，第一个小时通常发生在院前环境中。
一项前瞻性对照试验，由护理人员进行整群随机分组，比较院外心脏骤停自主循环恢复（ROSC）后第一个小时滴定氧与100%氧的效果。该试验在英国一个单一的紧急医疗服务（EMS）系统中进行，该系统将患者收治到三个急诊科。这是一项可行性试验，以确定是否能成功招募紧急医疗服务人员（英国护理人员）并实施干预措施。
共接触了157名护理人员，46名（29%）同意参与、被随机分组并接受培训。在研究期间，624名患者接受了复苏尝试。其中73次（12%）有效的复苏有研究护理人员在场。35名患者被纳入试验，32名（91%）被转运至医院，13名（37%）存活至90天。27/35（77%）的入组患者开始了干预措施。22/35（69%）的患者获得了可靠的血氧饱和度记录。33/35（94%）的患者完成了数据收集。
在英国，对院外心脏骤停自主循环恢复后第一个小时滴定氧与非限制氧进行随机试验可能是可行的。然而，符合条件的患者相对较少以及分配的干预措施启动不完全是未来研究面临的挑战。
ISRCTN 49548506于2016年11月24日进行回顾性注册。
