Thomas Gregory M, Prescott James T
University of Kansas School of Medicine, Department of Family and Community Medicine, South Central Medical Education Network Site, McPherson, KS.
Kans J Med. 2018 Nov 29;11(4):110-113. eCollection 2018 Nov.
Cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA) have interruption of manual chest compressions for airway management and breathing when performed by medical personnel trained by Advanced Cardiac Life Support (ACLS) standards. This interruption likely reduces blood flow and possibly survival. Traditional CPR (30:2 compressions to ventilations) was compared with continuous chest compressions, CCC (also termed Cardiocerebral Resuscitation, CCR) in a rural community.
A retrospective cohort analysis of three years of traditional CPR (June 2008 - May 2011) for OHCA was compared to three years of using CCC protocols (June 2011 - May 2014). Primary outcomes were survival at one and six months.
There were 58 0HCA patients in the six year study period (June 2008 - May 2014). Forty (69%) received CPR and 18 (31%) received CCC. Two (5%) survived at least one month with CPR and eight (44%) survived at least one month with CCC (p = 0.0007). After six months, 0/40 (0%) who received CPR had survived and 6/18 (33%) who received CCC survived (p = 0.0018). For the patient found in ventricular fibrillation or tachycardia (a shockable rhythm), 0/13 (0.0%) survived one month after CPR and 7/9 (78%) survived with CCC (p < 0.01). After six months 0/13 (0.0%) survived with CPR and 6/9 (67%) survived with CCC (p < 0.05).
For patients in a rural environment with OHCA, CCC had a more favorable outcome than traditional CPR. For the patient found in ventricular fibrillation or ventricular tachycardia, there was a profound survival benefit of CCC over CPR.
院外心脏骤停（OHCA）患者接受心肺复苏（CPR）时，由接受高级心血管生命支持（ACLS）标准培训的医务人员进行操作时，会中断胸外按压以进行气道管理和呼吸。这种中断可能会减少血流，进而可能影响存活率。在一个农村社区，对传统心肺复苏（30:2按压与通气比例）与持续胸外按压（CCC，也称为心脑复苏，CCR）进行了比较。
对三年传统心肺复苏（2008年6月至2011年5月）用于院外心脏骤停的情况与三年使用CCC方案（2011年6月至2014年5月）进行回顾性队列分析。主要结局指标为1个月和6个月时的存活率。
在六年研究期（2008年6月至2014年5月）内有58例院外心脏骤停患者。40例（69%）接受了心肺复苏，18例（31%）接受了持续胸外按压。2例（5%）接受心肺复苏的患者存活至少1个月，8例（44%）接受持续胸外按压的患者存活至少1个月（p = 0.0007）。6个月后，接受心肺复苏的40例患者中0例（0%）存活，接受持续胸外按压的18例患者中有6例（33%）存活（p = 0.0018）。对于心室颤动或心动过速（可电击心律）患者，接受心肺复苏后1个月时0/13例（0.0%）存活，接受持续胸外按压的9例中有7例（78%）存活（p < 0.01）。6个月后，接受心肺复苏的13例患者中0例（0.0%）存活，接受持续胸外按压的9例中有6例（67%）存活（p < 0.05）。
对于农村环境中的院外心脏骤停患者，持续胸外按压比传统心肺复苏有更有利的结局。对于心室颤动或室性心动过速患者，持续胸外按压比心肺复苏有显著的生存获益。
