Cohen T J, Goldner B G, Maccaro P C, Ardito A P, Trazzera S, Cohen M B, Dibs S R
Department of Medicine, North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030.
N Engl J Med. 1993 Dec 23;329(26):1918-21. doi: 10.1056/NEJM199312233292603.
Recent studies have demonstrated improved cardiopulmonary circulation during cardiac arrest with the use of a hand-held suction device (Ambu CardioPump) to perform active compression-decompression cardiopulmonary resuscitation (CPR). The purpose of this study was to compare active compression-decompression with standard CPR during cardiac arrests in hospitalized patients.
All patients over the age of 18 years who had a witnessed cardiac arrest while hospitalized at our center were enrolled in this trial; they were randomly assigned according to their medical-record numbers to receive either active compression-decompression or standard CPR. The study end points were the rates of initial resuscitation, survival at 24 hours, hospital discharge, and neurologic outcome. Compressions were performed according to the recommendations of the American Heart Association (80 to 100 compressions per minute; depth of compression, 3.8 to 5.1 cm [1.5 to 2 in.]; and 50 percent of the cycle spent in compression).
Sixty-two patients (45 men and 17 women) with a mean age (+/- SE) of 68 +/- 2 years were entered into the trial. Sixty-two percent of the patients who underwent active compression-decompression were initially resuscitated, as compared with 30 percent of the patients who received standard CPR (P < 0.03); 45 percent of the patients who underwent active compression-decompression survived for at least 24 hours, as compared with 9 percent of patients who underwent standard CPR (P < 0.004). Two of the 62 study patients survived to hospital discharge; both were randomly assigned to receive active compression-decompression. Neurologic outcome, as measured by the Glasgow coma score, was better with active compression-decompression (8.0 +/- 1.3) than with standard CPR (3.5 +/- 0.3; P < 0.02).
In this preliminary study, we found that, as compared with standard CPR, active compression-decompression CPR improved the rate of initial resuscitation, survival at 24 hours, and neurologic outcome after in-hospital cardiac arrest. Larger trials will be required to assess the potential benefit in terms of long-term survival.
最近的研究表明，在心脏骤停期间使用手持式吸引装置（Ambu 心肺复苏器）进行主动按压-减压心肺复苏（CPR）可改善心肺循环。本研究的目的是比较住院患者心脏骤停期间主动按压-减压心肺复苏与标准心肺复苏的效果。
所有在我们中心住院期间发生目击心脏骤停且年龄超过 18 岁的患者均纳入本试验；根据病历号将他们随机分组，分别接受主动按压-减压心肺复苏或标准心肺复苏。研究终点为初始复苏率、24 小时生存率、出院率和神经功能结局。按压操作按照美国心脏协会的建议进行（每分钟 80 至 100 次按压；按压深度为 3.8 至 5.1 厘米[1.5 至 2 英寸]；按压时间占周期的 50%）。
62 例患者（45 名男性和 17 名女性）进入试验，平均年龄（±标准误）为 68±2 岁。接受主动按压-减压心肺复苏的患者中，62%实现了初始复苏，而接受标准心肺复苏的患者中这一比例为 30%（P<0.03）；接受主动按压-减压心肺复苏的患者中有 45%存活至少 24 小时，相比之下，接受标准心肺复苏的患者中这一比例为 9%（P<0.004）。62 例研究患者中有 2 例存活至出院；两人均被随机分配接受主动按压-减压心肺复苏。通过格拉斯哥昏迷评分衡量的神经功能结局，主动按压-减压心肺复苏组（8.0±1.3）优于标准心肺复苏组（3.5±0.3；P<0.02）。
在这项初步研究中，我们发现，与标准心肺复苏相比，主动按压-减压心肺复苏提高了住院患者心脏骤停后的初始复苏率、24 小时生存率和神经功能结局。需要进行更大规模的试验来评估其对长期生存的潜在益处。
