Kool Mirjam, Atkins Dianne L, Van de Voorde Patrick, Maconochie Ian K, Scholefield Barnaby R
Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.
Paediatric Intensive Care Unit, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, United Kingdom.
Resusc Plus. 2021 Mar 30;6:100109. doi: 10.1016/j.resplu.2021.100109. eCollection 2021 Jun.
To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children.
This scoping review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. PubMed, MEDLINE, CINAHL and EMBASE were searched from the last ILCOR reviews until September 2020. We included all published studies evaluating the effect of echocardiography, EtCO, BP or NIRS guided CPR on clinical outcomes and quality of CPR.
We identified eight observational studies, including 288 children. Two case series reported the use of echocardiography, one in detecting pulmonary emboli, the second in cardiac standstill, where contractility was regained with the use of extracorporeal membrane oxygenation. The two studies describing EtCO were ambivalent regarding the association between mean values and any outcomes. Mean diastolic BP was associated with increased survival and favourable neurological outcome, but not with new substantive morbidity in two studies describing an overlapping population. NIRS values reflected changes in EtCO and cerebral blood volume index in two studies, with lower values in patients who did not achieve return of circulation.
Although there seems some beneficial effect of these intra-arrest variables, higher quality paediatric studies are needed to evaluate whether echocardiography, EtCO, BP or NIRS guided CPR could improve outcomes.
评估小儿心肺复苏（CPR）期间心脏超声、呼气末二氧化碳分压（EtCO）、有创动脉血压（BP）及近红外光谱（NIRS）的个体应用情况及预测价值。
本综述作为国际复苏联合会（ILCOR）持续证据评估过程的一部分进行，基于系统评价和Meta分析的首选报告项目（PRISMA）扩展版进行范围综述。检索了PubMed、MEDLINE、CINAHL和EMBASE数据库，检索时间从上次ILCOR综述至2020年9月。我们纳入了所有评估超声心动图、EtCO、BP或NIRS指导的CPR对临床结局和CPR质量影响的已发表研究。
我们确定了8项观察性研究，共288名儿童。两个病例系列报告了心脏超声的应用，一个用于检测肺栓塞，另一个用于心脏停搏，后者在使用体外膜肺氧合后恢复了收缩功能。两项描述EtCO的研究对于平均值与任何结局之间的关联存在矛盾。在两项描述重叠人群的研究中，平均舒张压与生存率提高及良好的神经学结局相关，但与新的实质性发病率无关。在两项研究中，NIRS值反映了EtCO和脑血容量指数的变化，未实现自主循环恢复的患者NIRS值较低。
尽管这些心脏骤停期间的变量似乎有一些有益作用，但仍需要更高质量的儿科研究来评估超声心动图、EtCO、BP或NIRS指导的CPR是否能改善结局。
