Pocock Helen, Deakin Charles D, Lall Ranjit, Smith Christopher M, Perkins Gavin D
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester SO21 2RU, United Kingdom.
Resusc Plus. 2022 May 11;10:100232. doi: 10.1016/j.resplu.2022.100232. eCollection 2022 Jun.
To determine the optimal first-shock energy level for biphasic defibrillation and whether fixed or escalating protocols for subsequent shocks are most effective.
We searched Medline, Embase, Cochrane CENTRAL, CINAHL, the Web of Science and national and international trial registry databases for papers published from database inception to January 2022. We reviewed reference lists of key papers to identify additional references. The population included adults sustaining non traumatic out-of-hospital cardiac arrest subject to attempted defibrillation. Studies of internal or monophasic defibrillation and studies other than randomised controlled trials or prospective cohorts were excluded. Two reviewers assessed study relevance. Data extraction and risk of bias assessment, using the ROBINS-I tool, were conducted by one reviewer and checked by a second reviewer. Data underwent intention-to-treat analysis.
We identified no studies evaluating first shock energy. Only one study ( = 738) comparing fixed versus escalating energy met eligibility criteria: a prospective cohort analysis of a randomised controlled trial of manual versus mechanical CPR. High fixed (360 J) energy was compared with an escalating (200-200/300-360 J) strategy. Researchers found 27.5% (70/255) of patients in the escalating energy group and 27.61% (132/478) in the fixed high energy group survived to hospital discharge (unadjusted risk ratio 0.99, 95% CI 0.73, 1.23). Results were of very low certainty as the study was at serious risk of bias.
This systematic review did not identify an optimal first-shock energy for biphasic defibrillation. We identified no survival advantage at 30 days when comparing 360 J fixed with 200 J escalating strategy.
确定双相波除颤的最佳首次电击能量水平，以及后续电击采用固定方案还是递增方案最为有效。
我们检索了Medline、Embase、Cochrane CENTRAL、CINAHL、科学网以及国内和国际试验注册数据库，以查找从数据库建立至2022年1月发表的论文。我们查阅了关键论文的参考文献列表以识别其他参考文献。研究对象包括接受除颤尝试的非创伤性院外心脏骤停成人。排除了内部或单相除颤研究以及非随机对照试验或前瞻性队列研究以外的其他研究。两名评审员评估研究的相关性。由一名评审员使用ROBINS-I工具进行数据提取和偏倚风险评估，并由另一名评审员进行检查。数据进行意向性分析。
我们未找到评估首次电击能量的研究。仅有一项研究（n = 738）比较固定能量与递增能量符合纳入标准：一项关于手动心肺复苏与机械心肺复苏的随机对照试验的前瞻性队列分析。将高固定能量（360 J）与递增能量（200 - 200/300 - 360 J）策略进行了比较。研究人员发现，递增能量组27.5%（70/255）的患者以及固定高能量组27.61%（132/478）的患者存活至出院（未调整风险比0.99，95%可信区间0.73，1.23）。由于该研究存在严重偏倚风险，结果的确定性非常低。
本系统评价未确定双相波除颤的最佳首次电击能量。比较360 J固定能量与200 J递增策略时，我们未发现30天时的生存优势。
