院外心脏骤停中被动抬腿的临床结局和安全性：一项随机对照试验。
Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial.
机构信息
Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain.
Emergency Department, Sant Joan University Hospital, Reus, Spain.
出版信息
Crit Care. 2021 May 25;25(1):176. doi: 10.1186/s13054-021-03593-7.
BACKGROUND
There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).
METHODS
We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors.
RESULTS
In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60-82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7-1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8-3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909-1500) vs 1239 mg (IQR 900-1507), p = 0.82] or brain weight [1352 mg (IQR 1227-1457) vs 1380 mg (IQR 1255-1470), p = 0.43] among the 106 autopsies performed.
CONCLUSION
In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197 .
背景
有数据表明，被动抬腿（PLR）可以改善心肺复苏（CPR）期间的血液动力学。本试验旨在确定在院外心脏骤停（OHCA）中 CPR 期间进行 PLR 的有效性和安全性。
方法
我们进行了一项随机对照试验，对结局进行了盲法评估，将 OHCA 成年患者分为 PLR 组或平卧位组。试验在塔拉戈纳地区进行。主要终点是出院时存活且神经功能良好，定义为脑功能分类（CPC 1-2）。为了研究可能的不良反应，我们评估了首次胸部 X 光片上的肺部并发症、幸存者 CT 上的脑水肿以及非幸存者的脑和肺重量。
结果
共纳入 588 例随机病例，其中 301 例接受 PLR 治疗，287 例为对照组。总体而言，67.8%为男性，中位年龄为 72（IQR 60-82）岁。出院时，PLR 组有 3.3%和对照组有 3.5%的患者存活且 CPC 1-2（OR 0.9；95%CI 0.4-2.3，p=0.91）。所有患者（OR 1.0；95%CI 0.7-1.6，p=0.95）和初始可除颤节律患者（OR 1.7；95%CI 0.8-3.4，p=0.15）入院时的存活率均无显著差异。胸部 X 光片上的肺部并发症发生率[7（25.9%）vs 5（17.9%），p=0.47]和 CT 上的脑水肿[5（29.4%）vs 10（32.6%），p=0.84]差异无统计学意义。肺重量[1223mg（IQR 909-1500）vs 1239mg（IQR 900-1507），p=0.82]或脑重量[1352mg（IQR 1227-1457）vs 1380mg（IQR 1255-1470），p=0.43]在 106 例进行的尸检中无差异。
结论
在本试验中，CPR 期间的 PLR 并未提高出院时存活且 CPC 1-2 的比例。未发现不良反应的证据。
临床试验注册
ClinicalTrials.gov：NCT01952197，注册日期：2013 年 9 月 27 日，https://clinicaltrials.gov/ct2/show/NCT01952197。
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