Considine Julie, Couper Keith, Greif Robert, Ong Gene Yong-Kwang, Smyth Michael A, Ng Kee Chong, Kidd Tracy, Mariero Olasveengen Theresa, Bray Janet
Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety in the Institute for Health Transformation, Geelong, VIC, Australia.
Eastern Health, Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia.
Resusc Plus. 2024 Nov 15;20:100820. doi: 10.1016/j.resplu.2024.100820. eCollection 2024 Dec.
Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.
This scoping review, conducted using Arksey and O'Malley's framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. 'Obese' was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.
36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.
The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.
鉴于全球肥胖患病率不断上升，国际复苏联合委员会（ILCOR）委托进行了这项范围综述，以探究目前关于肥胖患者（成人和儿童）心脏骤停治疗及预后的证据。
本范围综述采用阿克西和奥马利的框架进行，并按照PRISMA-ScR指南报告，纳入了肥胖患者心肺复苏的研究。“肥胖”根据每项研究自行定义。检索了Medline、EMBASE和考克兰数据库，检索时间从建库至2024年10月1日。叙述性综合分析遵循非Meta分析的综合报告指南（SWiM）。
共纳入36项研究：2项儿科研究和34项成人研究。14项研究报告了院外心脏骤停（OHCA）情况，12项报告了院内心脏骤停（IHCA）情况，8项同时报告了OHCA和IHCA情况：2项研究未报告心脏骤停发生地点。最常见的结局是生存（n = 29）、神经功能结局（n = 17）和恢复自主循环（ROSC，n = 7）。在成人中，神经功能结局、出院存活、长期存活（数月至数年）和ROSC方面的结果各不相同。在儿童中，有两项研究表明，肥胖儿童的神经功能结局比正常体重儿童更差，存活率和ROSC更低。很少有研究报告复苏质量指标或技术，没有研究报告对心肺复苏技术的调整。
结果的差异并不表明迫切需要偏离标准心肺复苏方案，然而，有一些证据表明肥胖成人的心肺复苏持续时间可能更长，这可能对人员配备和资源有影响。
