Kemper M, Zech A, Lazarovici M, Zwissler B, Prückner S, Meyer O
Institute of Emergency Medicine and Medical Management, LMU Munich, Munich, Germany.
Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen, 52074, Germany.
Anaesthesist. 2019 Aug;68(8):546-554. doi: 10.1007/s00101-019-0623-x.
Charging defibrillators prior to analyzing heart rhythms may decrease the no-flow time during rhythm check pauses while resuscitating in cardiac arrest. Although this anticipatory method is already used in some centers little is known about its safety. This study was carried out to confirm the safety and feasibility of the anticipatory method. It was hypothesized that this anticipatory method results in shorter total no-flow times, while other parameters of defibrillation efficacy including defibrillator safety and minimization of peri-shock pauses are unchanged.
This manikin study assigned 243 medical students randomly to study groups, 121 to the anticipatory method and 122 to the recommended European Resuscitation Council (ERC) algorithm. Of these 237 students ultimately underwent training (112 anticipatory method vs. 125 ERC algorithm). Participants were assessed and video recorded during a simulated cardiac arrest scenario which included three different heart rhythms (ventricular fibrillation [VF], pulseless ventricular tachycardia [pVT], asystole) in randomized order. Video and software analyses were performed. Defibrillation safety was assessed using a 17-item checklist defined beforehand.
A total of 203 simulated cardiac arrests (75 anticipatory method and 128 ERC 2010 algorithm) were analyzed. The anticipatory method did not significantly reduce no-flow time (25.8 s, standard deviation, SD 7.4 s vs. 27.4 s SD 8.4 s, p = 0.19); however, peri-shock pauses were significantly longer in the anticipatory group compared to the ERC 2010 group (9.5 s SD 2.8 s vs. 3.3 s SD 1.9 s, p < 0.001). No significant difference concerning defibrillation safety between the groups was observed according to the 17-item checklist (14.6 SD 1.6 vs. 15.0 SD 1.4, p = 0.07).
Charging defibrillators before rhythm analysis did not decrease total no-flow time in simulated cardiac arrests but resulted in significantly longer peri-shock pauses exceeding 5 s. No significant differences in defibrillation safety were observed between the groups.
在分析心律之前对除颤器进行充电，可能会减少心脏骤停复苏期间心律检查暂停时的无血流时间。尽管这种预充能方法已在一些中心使用，但其安全性却鲜为人知。本研究旨在证实该预充能方法的安全性和可行性。研究假设这种预充能方法能缩短总的无血流时间，而除颤效果的其他参数，包括除颤器安全性和电击周围暂停时间的最小化，保持不变。
本人体模型研究将243名医学生随机分配到各研究组，121人采用预充能方法，122人采用欧洲复苏委员会（ERC）推荐的算法。这237名学生最终接受了培训（112人采用预充能方法，125人采用ERC算法）。在模拟心脏骤停场景中对参与者进行评估并录像，该场景按随机顺序包括三种不同的心律（室颤[VF]、无脉性室性心动过速[pVT]、心脏停搏）。进行了视频和软件分析。使用预先定义的17项检查表评估除颤安全性。
共分析了203次模拟心脏骤停（75次采用预充能方法，128次采用ERC 2010算法）。预充能方法并未显著缩短无血流时间（25.8秒，标准差[SD]7.4秒，而27.4秒，SD 8.4秒，p = 0.19）；然而，与ERC 2010组相比，预充能组的电击周围暂停时间明显更长（9.5秒，SD 2.8秒，而3.3秒，SD 1.9秒，p < 0.001）。根据17项检查表，两组之间在除颤安全性方面未观察到显著差异（14.6，SD 1.6，而15.0，SD 1.4，p = 0.07）。
在心律分析前对除颤器进行充电，并未减少模拟心脏骤停时的总无血流时间，但导致电击周围暂停时间明显延长，超过5秒。两组之间在除颤安全性方面未观察到显著差异。
