Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis.
Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis.
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DOI：
10.1016/s0140-6736(10)61454-7
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发表时间：
2010-11-06
期刊：
影响因子：
168.9
通讯作者：
Nagele, Peter
中科院分区：
文献类型：
--
作者：
Huepfl, Michael;Selig, Harald F.;Nagele, Peter
有证据表明，在院外心脏骤停中，调度员辅助胸外按压仅旁观者CPR可能上级标准CPR（胸外按压和抢救通气），但最近的临床试验并未观察到改善的结局。该研究的目的是确定仅胸外按压CPR与院外心脏骤停后生存率之间的关系。在MEDLINE和EMBASE数据库中系统检索并识别了截至2010年8月发表的研究。对于主要荟萃分析，仅纳入了前瞻性随机分配调度员指示在院外成人心脏骤停患者中进行仅胸外按压与标准旁观者CPR的临床试验;对于次要荟萃分析，纳入了区分标准CPR和仅胸外按压CPR的观察性队列研究。所有研究都需要包含生存数据。提取研究特征、方法和结局（自主循环恢复、出院前生存率、30天生存率和有利的神经学结局）的数据。由于研究间缺乏异质性（I2 0%），两项荟萃分析均采用固定效应模型。所有三项已发表的随机临床试验均纳入荟萃分析。汇总分析显示，与标准CPR相比，调度员辅助胸外按压仅旁观者CPR治疗成人院外心脏骤停的存活率提高了22%（风险比[RR] 1.22 [95%置信区间{CI}，1.01 - 1.47]; I2，0%）。生存率的绝对增加为2.4%;需要治疗的人数为41人。次要荟萃分析包括7项旁观者CPR（非调度员辅助）的观察性研究，显示两种CPR技术之间无差异（RR，0.96 [95%CI，0.83 - 1.11]; I2，0%）。与标准CPR相比，调度员辅助胸外按压仅旁观者CPR与院外心脏骤停后成人患者的生存率提高相关。
Evidence suggests that dispatcher-assisted chest compression-only bystander CPR may be superior to standard CPR (chest compressions and rescue ventilation) in out-of-hospital cardiac arrest, yet recent clinical trials did not observe improved outcomes. The goal of the study was to determine the association between chest compression-only CPR and survival after out-of-hospital cardiac arrest. Studies published until August 2010 were systematically searched and identified in MEDLINE and EMBASE databases. For the primary meta-analysis only clinical trials were included that prospectively randomized dispatcher instructions to chest compression-only versus standard bystander CPR in out-of-hospital adult cardiac arrest patients; for the secondary meta-analysis observational cohort studies were included that distinguished between standard CPR and chest compression-only CPR. All studies were required to contain survival data. Data on study characteristics, methods and outcomes (return of spontaneous circulation, survival to discharge, 30-day survival, and favourable neurologic outcome) were extracted. A fixed-effects model was used for both meta-analyses for lack of heterogeneity among the studies (I2 0%). All three published randomized clinical trials were included in the meta-analysis. The pooled analyses shows that dispatcher-assisted chest compression-only bystander CPR for adult out-of-hospital cardiac arrest was associated with a 22% improved chance of survival (risk ratio [RR] 1.22 [95% confidence interval {CI}, 1.01 – 1.47]; I2, 0%) compared to standard CPR. The absolute increase in survival was 2.4%; the number needed to treat was 41. The secondary meta-analysis included seven observational studies of bystander-CPR (not dispatcher-assisted) and showed no difference between the two CPR techniques (RR, 0.96 [95% CI, 0.83 – 1.11]; I2, 0%). Dispatcher-assisted chest compression-only bystander CPR is associated with improved survival in adult patients after out-of-hospital cardiac arrest compared to standard CPR.