Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France.
Emergency Department and Mobile Intensive Care Unit, University Hospital of Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France.
Resuscitation. 2024 Nov;204:110406. doi: 10.1016/j.resuscitation.2024.110406. Epub 2024 Oct 2.
The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.
We conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022.Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO value measured during CPR.
122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, P < 0.001). Mean differences in peak ETCO between study periods did not vary according to the first recorded cardiac rhythm (P for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.
ETCO values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.
与传统（C）CPR 相比，联合控制性自动头部/胸部抬高、主动压缩-减压（ACD）心肺复苏（CPR）和阻抗阈值设备（ITD-16）的 AHUP-CPR 可降低颅内压并增加循环和神经健全的存活，在猪中。本研究旨在探讨 AHUP-CPR 是否会增加呼气末（ET）CO，这是心输出量和器官灌注的非侵入性标志物，与见证性院外心脏骤停患者的 C-CPR 相比。
我们在 2019 年 10 月至 2022 年 10 月期间在法国进行了一项前瞻性、单臂、干预前后的临床试验。消防员在干预前阶段用手动 C-CPR 治疗患者，并在干预后阶段用 AHUP-CPR 治疗。在两个研究期间，由配备医生的二线反应车辆提供高级生命支持。主要结局是 CPR 期间测量的峰值 ETCO 值。
共纳入 122 名年龄平均为 67 岁（标准差[SD]，17）的患者（干预前 59 名，干预后 63 名）。基于意向治疗分析，干预前（20.1mmHg，SD，16.3）和干预后（19.2mmHg，SD，16.3）期间的平均基线 ETCO 值相似。CPR 期间的平均峰值 ETCO 值分别为 30.3mmHg（SD，13.1）和 40.7mmHg（SD，17.8）（干预前和干预后研究期间的平均差异，10.6mmHg，95%置信区间，4.6 至 16.1，P<0.001）。根据首次记录的心脏节律，研究期间的峰值 ETCO 差异无统计学意义（交互作用 P=0.99）。循环恢复率[19（32.2%）与 21（33.3%）]、入院存活率[17（28.8%）与 19（30.2%）]和 30 天生存且神经功能良好的比例[8（13.6%）与 7（11.1%）]在研究期间无差异。
无论呈现的心脏节律如何，AHUP-CPR 期间的 ETCO 值均达到非心脏骤停正常生理水平的范围，并且明显高于 C-CPR。
