Holmberg Mathias J, Nicholson Tonia, Nolan Jerry P, Schexnayder Steve, Reynolds Joshua, Nation Kevin, Welsford Michelle, Morley Peter, Soar Jasmeet, Berg Katherine M
Beth Israel Deaconess Medical Center, Boston, MA, USA; Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Waikato District Hospital, Hamilton, New Zealand.
Resuscitation. 2020 Jul;152:107-115. doi: 10.1016/j.resuscitation.2020.04.031. Epub 2020 May 8.
To perform a systematic review and meta-analysis of the literature on oxygenation and ventilation targets after successful resuscitation from cardiac arrest in order to inform an update of international guidelines.
The review was performed according to PRISMA and registered on PROSPERO (ID: X). Medline, EMBASE, and the Cochrane Library were searched on August 22, 2019. The population included both adult and pediatric patients with cardiac arrest. Two investigators reviewed abstracts, extracted data, and assessed the risk of bias. Meta-analyses were performed for studies without excessive bias. Certainty of evidence was evaluated using GRADE.
We included 7 trials and 36 observational studies comparing oxygenation or ventilation targets. Most of the trials and observational studies included adults with out-of-hospital cardiac arrest. There were 6 observational studies in children. Bias for trials ranged from low to high risk, with group imbalances and blinding being primary concerns. Bias for observational studies was rated as serious or critical risk with confounding and exposure classification being primary sources of bias. Meta-analyses including two trials comparing low vs high oxygen therapy and two trials comparing hypercapnia vs no hypercapnia were inconclusive. Point estimates of individual studies generally favored normoxemia and normocapnia over hyper- or hypoxemia and hyper- or hypocapnia.
We identified a large number of studies related to oxygenation and ventilation targets in cardiac arrest. The majority of studies did not reach statistical significance and were limited by excessive risk of bias. Point estimates of individual studies generally favored normoxemia and normocapnia.
对心脏骤停成功复苏后的氧合和通气目标相关文献进行系统评价和荟萃分析，以便为国际指南的更新提供依据。
本评价按照系统评价和Meta分析的首选报告项目（PRISMA）进行，并在国际前瞻性系统评价注册库（PROSPERO，注册号：X）登记。于2019年8月22日检索了医学期刊数据库（Medline）、荷兰医学文摘数据库（EMBASE）和考克兰图书馆。研究对象包括成人心脏骤停患者和儿童心脏骤停患者。两名研究人员对摘要进行了审查，提取了数据，并评估了偏倚风险。对偏倚风险不过高的研究进行了荟萃分析。采用GRADE评估证据的确定性。
我们纳入了7项试验和36项观察性研究，比较了氧合或通气目标。大多数试验和观察性研究纳入了院外心脏骤停的成人患者。有6项观察性研究纳入了儿童患者。试验的偏倚风险从低到高不等，组间不均衡和盲法是主要问题。观察性研究的偏倚风险被评为严重或极严重风险，并以混杂因素和暴露分类作为主要偏倚来源。包括两项比较低氧治疗与高氧治疗以及两项比较高碳酸血症与非高碳酸血症的试验的荟萃分析结果尚无定论。个别研究的点估计值一般更支持正常氧血症和正常碳酸血症，而非高氧或低氧血症以及高碳酸或低碳酸血症。
我们识别出大量与心脏骤停时氧合和通气目标相关的研究。大多数研究未达到统计学显著性，且受过高偏倚风险的限制。个别研究的点估计值一般更支持正常氧血症和正常碳酸血症。
