Department of Prehospital and Emergency Care, Department of Anaesthesiology and Intensive Care, Queen Silvia's Children's Hospital Sahlgrenska University Hospital, Sweden.
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Department of Cardiology, Sahlgrenska University Hospital, Sweden.
Resuscitation. 2019 Apr;137:94-101. doi: 10.1016/j.resuscitation.2019.02.017. Epub 2019 Feb 18.
The use of passive leg raising (PLR) in cardiopulmonary resuscitation (CPR) is sometimes discussed and even recommended. The effect of this intervention has never been properly addressed. We planned to determine whether PLR in out-of-hospital cardiac arrest (OHCA) is associated with an improved survival to 30 days.
In eight districts in western Sweden, we introduced PLR within five minutes after the start of CPR, among patients with OHCA. Patients in whom PLR was not performed, within the same district, served as a control group. Thirty-day survival was the primary endpoint. A propensity score analysis, as well as a standard multivariate analysis, was used to assess possible differences between the two groups.
We identified 3554 patients with OHCA from the eight districts. Forty-four percent were treated with PLR during CPR. Patients who received PLR differed from those who did not, by having more risk factors for an adverse outcome (fewer crew-witnessed cases, more OHCA at home, a greater need for medication and prolonged delays to treatment). The overall survival to 30 days was 7.9% among patients who received PLR versus 13.5% among those who did not. A comparison of the groups, using propensity score matching, revealed a 30 -day survival of 8.6% in the PLR group versus 8.2% in the control group (odds ratio 1.07; 95% confidence interval 0.80-1.44).
In an observational study, we introduced PLR as an addition to standard treatment in patients with OHCA. We did not find any evidence that this treatment improves survival to 30 days.
被动抬腿（PLR）在心肺复苏（CPR）中的应用有时会被讨论，甚至被推荐。但这一干预措施的效果从未得到妥善解决。我们计划确定在院外心脏骤停（OHCA）中PLR 是否与 30 天生存率的提高相关。
在瑞典西部的八个地区，我们在 CPR 开始后 5 分钟内对 OHCA 患者进行 PLR。同一地区未进行 PLR 的患者作为对照组。30 天生存率为主要终点。使用倾向评分分析和标准多变量分析来评估两组之间的可能差异。
我们从八个地区确定了 3554 名 OHCA 患者。44%的患者在 CPR 期间接受了 PLR。接受 PLR 的患者与未接受 PLR 的患者不同，具有更多不良预后的危险因素（目击案例较少，更多 OHCA 发生在家中，需要更多药物治疗和治疗时间延长）。接受 PLR 的患者 30 天生存率为 7.9%，而未接受 PLR 的患者为 13.5%。使用倾向评分匹配对两组进行比较，PLR 组 30 天生存率为 8.6%，对照组为 8.2%（优势比 1.07；95%置信区间 0.80-1.44）。
在一项观察性研究中，我们将 PLR 作为 OHCA 患者标准治疗的附加治疗方法。我们没有发现任何证据表明这种治疗方法可以提高 30 天生存率。
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