Emergency Department, Affiliated Zhongshan Hospital of Dalian University, Dalian city, Liaoning Province, China.
Emergency Department, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
Scand J Trauma Resusc Emerg Med. 2019 Dec 27;27(1):116. doi: 10.1186/s13049-019-0690-7.
Cardiopulmonary resuscitation is the most urgent and critical step in the rescue of patients with cardiac arrest. However, only about 10% of patients with out-of-hospital cardiac arrest survive to discharge. Surprisingly, there is growing evidence that open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation. Meanwhile, The Western Trauma Association and The European Resuscitation Council encouraged thoracotomy in certain circumstances for trauma patients. But whether open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation remains undetermined. Therefore, the aim of this study was to summarize current studies on open-chest cardiopulmonary resuscitation in a systematic review, comparing it to closed-chest cardiopulmonary resuscitation, in a meta-analysis.
In this systematic review and meta-analysis, we searched the PubMed, EmBase, Web of Science, and Cochrane Library databases from inception to May 2019 investigating the effect of open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in patients with cardiac arrest, without language restrictions. Statistical analysis was performed using Stata 12.0 software. The primary outcome was return of spontaneous circulation. The secondary outcome was survival to discharge.
Seven observational studies were eligible for inclusion in this meta-analysis involving 8548 patients. No comparative randomized clinical trial was reported in the literature. There was no significant difference in return of spontaneous circulation and survival to discharge between open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in cardiac arrest patients. The odds ratio (OR) were 0.92 (95%CI 0.36-2.31, P > 0.05) and 0.54 (95%CI 0.17-1.78, P > 0.05) for return of spontaneous circulation and survival to discharge, respectively. Subgroup analysis of cardiac arrest patients with trauma showed that closed-chest cardiopulmonary resuscitation was associated with higher return of spontaneous circulation compared with open-chest cardiopulmonary resuscitation (OR = 0.59 95%CI 0.37-0.94, P < 0.05). And subgroup analysis of cardiac arrest patients with non-trauma showed that open-chest cardiopulmonary resuscitation was associated with higher ROSC compared with closed-chest cardiopulmonary resuscitation (OR = 3.12 95%CI 1.23-7.91, P < 0.05).
In conclusion, for patients with cardiac arrest, we should implement closed-chest cardiopulmonary resuscitation as soon as possible. However, for cardiac arrest patients with chest trauma who cannot perform closed-chest cardiopulmonary resuscitation, open-chest cardiopulmonary resuscitation should be implemented as soon as possible.
心肺复苏是抢救心搏骤停患者最紧急、最关键的步骤。然而，仅有约 10%的院外心搏骤停患者存活至出院。令人惊讶的是，越来越多的证据表明开胸心肺复苏优于闭胸心肺复苏。同时，西方创伤协会和欧洲复苏委员会鼓励在某些情况下对创伤患者行开胸术。但是，开胸心肺复苏是否优于闭胸心肺复苏仍未确定。因此，本研究旨在通过系统评价总结目前关于开胸心肺复苏的研究，并通过荟萃分析将其与闭胸心肺复苏进行比较。
在这项系统评价和荟萃分析中，我们检索了从建库到 2019 年 5 月的 PubMed、EmBase、Web of Science 和 Cochrane Library 数据库，调查了心搏骤停患者中开胸心肺复苏和闭胸心肺复苏的效果，不限制语言。使用 Stata 12.0 软件进行统计学分析。主要结局为自主循环恢复。次要结局为出院存活率。
纳入的 7 项观察性研究符合纳入标准，共涉及 8548 例患者。文献中未报道比较随机临床试验。心搏骤停患者中，开胸心肺复苏与闭胸心肺复苏在自主循环恢复和出院存活率方面无显著差异。自主循环恢复的比值比（OR）为 0.92（95%CI 0.36-2.31，P＞0.05），出院存活率的 OR 为 0.54（95%CI 0.17-1.78，P＞0.05）。创伤性心搏骤停患者的亚组分析显示，与开胸心肺复苏相比，闭胸心肺复苏更有助于自主循环恢复（OR=0.59，95%CI 0.37-0.94，P＜0.05）。非创伤性心搏骤停患者的亚组分析显示，与闭胸心肺复苏相比，开胸心肺复苏更有助于自主循环恢复（OR=3.12，95%CI 1.23-7.91，P＜0.05）。
总之，对于心搏骤停患者，我们应尽快实施闭胸心肺复苏。然而，对于不能进行闭胸心肺复苏的创伤性心搏骤停患者，应尽快实施开胸心肺复苏。
