Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Emerg Med Australas. 2020 Oct;32(5):769-776. doi: 10.1111/1742-6723.13505. Epub 2020 Mar 26.
To describe the characteristics and outcomes of cardiopulmonary resuscitation (CPR)-induced consciousness patients from a large database of out-of-hospital cardiac arrest (OHCA).
Included were adult patients, attended between January 2007 and December 2018 by the Queensland Ambulance Service, where resuscitation was attempted by paramedics. Manual review of records was undertaken to identify CPR-induced consciousness cases. Patients exhibiting purposeful limb/body movement during CPR, with or without displaying other signs, were considered to be CPR-induced consciousness. Characteristics and outcomes of CPR-induced consciousness patients were compared to those without CPR-induced consciousness.
A total of 23 011 OHCA patients were included; of these, 52 (0.23%) were CPR-induced consciousness. This translates into an incidence rate of 2.3 cases per 1000 adult resuscitation attempts over 12 years. Combativeness/agitation was the most common sign of CPR-induced consciousness, described in 34.6% (18/52) of patients. CPR-induced consciousness patients had numerically higher rates of return of spontaneous circulation on hospital arrival (51.9% vs 28.6%), discharge survival (46.2% vs 15.1%) and 30-day survival (46.2% vs 14.7%), than those without CPR-induced consciousness; however, CPR-induced consciousness was not found to be an independent predictor of survival. Higher proportions of CPR-induced consciousness patients had arrest witnessed by paramedics, occurring in public places, of cardiac aetiology and initial shockable rhythm, than patients without CPR-induced consciousness.
CPR-induced consciousness in OHCA appears to be associated with higher survival rates. Standardised guidelines on recognition and management of CPR-induced consciousness remain to be established.
从院外心脏骤停（OHCA）的大型数据库中描述心肺复苏（CPR）诱导意识患者的特征和结局。
纳入 2007 年 1 月至 2018 年 12 月期间昆士兰救护车服务机构救治的成年患者，由护理人员尝试进行复苏。对记录进行手动审查，以确定 CPR 诱导意识的病例。CPR 诱导意识患者被定义为在 CPR 过程中表现出有目的的肢体/身体运动，无论是否表现出其他迹象。比较 CPR 诱导意识患者与无 CPR 诱导意识患者的特征和结局。
共纳入 23011 例 OHCA 患者，其中 52 例（0.23%）为 CPR 诱导意识。这相当于 12 年间每 1000 例成人复苏尝试中有 2.3 例发生 CPR 诱导意识。在 52 例 CPR 诱导意识患者中，最常见的 CPR 诱导意识迹象是对抗性/激动，占 34.6%（18/52）。CPR 诱导意识患者在到达医院时自主循环恢复的比例更高（51.9%比 28.6%）、出院存活率（46.2%比 15.1%）和 30 天存活率（46.2%比 14.7%）也更高，但 CPR 诱导意识并不是存活的独立预测因素。CPR 诱导意识患者中，有更多的患者被护理人员目击到心脏骤停，发生在公共场所，心源性病因，初始为可除颤节律，与无 CPR 诱导意识患者相比。
OHCA 中 CPR 诱导意识似乎与更高的存活率相关。关于 CPR 诱导意识的识别和管理的标准化指南仍有待制定。
