机械主动按压-减压与标准机械心肺复苏：一项院外心脏骤停的随机血流动力学研究。
Mechanical active compression-decompression versus standard mechanical cardiopulmonary resuscitation: A randomised haemodynamic out-of-hospital cardiac arrest study.
作者信息
Berve Per Olav, Hardig Bjarne Madsen, Skålhegg Tore, Kongsgaard Håvard, Kramer-Johansen Jo, Wik Lars
机构信息
Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
Clinical Sciences, Helsingborg, Section II, Faculty of Medicine, Lund University, Sweden; Stryker/Jolife AB, Lund, Sweden.
出版信息
Resuscitation. 2022 Jan;170:1-10. doi: 10.1016/j.resuscitation.2021.10.026. Epub 2021 Oct 25.
BACKGROUND
Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) utilises a suction cup to lift the chest-wall actively during the decompression phase (AD). We hypothesised that mechanical ACD-CPR (Intervention), with AD up to 30 mm above the sternal resting position, would generate better haemodynamic results than standard mechanical CPR (Control).
METHODS
This out-of-hospital adult non-traumatic cardiac arrest trial was prospective, block-randomised and non-blinded. We included intubated patients with capnography recorded during mechanical CPR. Exclusion criteria were pregnancy, prisoners, and prior chest surgery. The primary endpoint was maximum tidal carbon dioxide partial pressure (pCO) and secondary endpoints were oxygen saturation of cerebral tissue (SctO), invasive arterial blood pressures and CPR-related injuries. Intervention device lifting force performance was categorised as Complete AD (≥30 Newtons) or Incomplete AD (≤10 Newtons). Haemodynamic data, analysed as one measurement for each parameter per ventilation (Observation Unit, OU) with non-linear regression statistics are reported as mean (standard deviation). A two-sided p-value < 0.05 was considered as statistically significant.
RESULTS
Of 221 enrolled patients, 210 were deemed eligible (Control 109, Intervention 101). The Control vs. Intervention results showed no significant differences for pCO: 29(17) vs 29(18) mmHg (p = 0.86), blood pressures during compressions: 111(45) vs. 101(68) mmHg (p = 0.93) and decompressions: 21(20) vs. 18(18) mmHg (p = 0.93) or for SctO%: 55(36) vs. 57(9) (p = 0.42). The 48 patients who received Complete AD in > 50% of their OUs had higher SctO than Control patients: 58(11) vs. 55(36)% (p < 0.001).
CONCLUSIONS
Mechanical ACD-CPR provided similar haemodynamic results to standard mechanical CPR. The Intervention device did not consistently provide Complete AD.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov identifier (NCT number): NCT02479152. The Haemodynamic Effects of Mechanical Standard and Active Chest Compression-decompression During Out-of-hospital CPR.
背景
主动按压-减压心肺复苏术（ACD-CPR）在减压阶段（AD）使用吸盘主动抬起胸壁。我们假设，机械ACD-CPR（干预组），减压幅度达胸骨静止位置上方30毫米，会比标准机械心肺复苏术（对照组）产生更好的血流动力学结果。
方法
这项院外成人非创伤性心脏骤停试验是前瞻性、区组随机且非盲法的。我们纳入了在机械心肺复苏期间记录有二氧化碳波形图的插管患者。排除标准为妊娠、囚犯和既往胸部手术史。主要终点是最大潮气末二氧化碳分压（pCO），次要终点是脑组织氧饱和度（SctO）、有创动脉血压和与心肺复苏相关的损伤。干预设备的提升力性能分为完全AD（≥30牛顿）或不完全AD（≤10牛顿）。血流动力学数据，采用非线性回归统计分析，每个通气周期每个参数作为一次测量（观察单位，OU），报告为均值（标准差）。双侧p值<0.05被认为具有统计学意义。
结果
在221名登记患者中，210名被认为符合条件（对照组109名，干预组101名）。对照组与干预组的结果显示，pCO无显著差异：29（17）对29（18）毫米汞柱（p = 0.86），按压期间血压：111（45）对101（68）毫米汞柱（p = 0.93），减压期间血压：21（20）对18（18）毫米汞柱（p = 0.93），或SctO%无显著差异：55（36）对57（9）（p = 0.42）。在超过50%的观察单位接受完全AD的48名患者的SctO高于对照组患者：58（11）对55（36）%（p < 0.001）。
结论
机械ACD-CPR与标准机械心肺复苏术产生的血流动力学结果相似。干预设备并未始终提供完全AD。
临床试验注册
ClinicalTrials.gov标识符（NCT编号）：NCT02479152。院外心肺复苏期间标准机械和主动胸外按压-减压的血流动力学效应。
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