Load-distributing-band cardiopulmonary resuscitation for out-of-hospital cardiac arrest increases regional cerebral oxygenation: a single-center prospective pilot study.
Load-distributing-band cardiopulmonary resuscitation for out-of-hospital cardiac arrest increases regional cerebral oxygenation: a single-center prospective pilot study.
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DOI：
10.1186/s13049-015-0182-3
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发表时间：
2015-11-14
期刊：
影响因子：
--
通讯作者：
Shimazu T
中科院分区：
文献类型：
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作者：
Ogawa Y;Shiozaki T;Hirose T;Ohnishi M;Nakamori Y;Ogura H;Shimazu T
尽管在治疗策略和改进的指南的进步，发病率和死亡率院外心脏骤停（OHCA）仍然很高。特别是，神经预后是最重要的问题之一，即使OHCA患者的脑保护治疗近年来有了很大的改善，由于紧急心脏骤停后的干预措施，如轻度治疗性低温，早期经皮冠状动脉介入治疗，体外心肺复苏（CPR）的发展。最近，脑局部氧饱和度（rSO2）作为评价脑氧合的方法受到关注。我们曾报道，如果心脏骤停患者不能恢复自主循环，常规胸外按压不能改善rSO 2。然而，目前尚不清楚机械CPR设备是否有助于改善rSO2。本研究的目的是评估负荷分布带CPR（LDB-CPR）对rSO2的影响。在这项前瞻性研究中，LDB-CPR是在患者到达医院时使用AutoPulseTM设备开始的。在机械CPR期间，从患者的前额连续记录rSO2值。根据日本复苏理事会指南2010对OHCA患者进行CPR，但使用AutoPulse TM代替手动胸外按压除外。从2012年12月至2013年12月，34例OHCA患者（平均年龄，75.6 ± 12.8岁）入选本研究。从发现心脏性虚脱到到达医院的时间为31.0 ± 11.4 min。与开始LDB-CPR前的rSO2值38.9 ± 0.7%相比，开始LDB-CPR后4、8和12分钟的rSO2值显著增加（分别为44.0 ± 0.9%、45.2 ± 0.8%和45.5 ± 0.8%，p <0.05）。LDB-CPR可显著增加心脏骤停患者复苏时rSO2。
Despite advances in therapeutic strategies and improved guidelines, morbidity and mortality rates for out-of-hospital cardiac arrest (OHCA) remain high. Especially, neurological prognosis is one of the most important problems even though brain protection therapy for patients with OHCA has improved greatly in recent years due to the development of emergency post-cardiac arrest interventions such as mild therapeutic hypothermia, early percutaneous coronary intervention, and extracorporeal cardiopulmonary resuscitation (CPR). Recently, cerebral regional oxygen saturation (rSO2) has received attention as a method for evaluation of cerebral oxygenation. We have reported that conventional chest compression did not improve the rSO2 of cardiac arrest patients if they did not achieve return of spontaneous circulation. It is, however, unclear whether a mechanical CPR device is helpful in improving rSO2. The purpose of this study was to evaluate the effects of load-distributing-band CPR (LDB-CPR) on rSO2. In this prospective study, LDB-CPR was begun for OHCA with the AutoPulseTM device on patient arrival at hospital. During mechanical CPR, rSO2 values were recorded continuously from the forehead of the patients. CPR for patients with OHCA was performed according to the Japan Resuscitation Council Guidelines 2010 except for using the AutoPulseTM instead of manual chest compression. From December 2012 to December 2013, 34 patients (mean age, 75.6 ± 12.8 years) with OHCA were included in this study. Duration of time from recognition of cardiac collapse to arrival to hospital was 31.0 ± 11.4 min. Compared with the rSO2 value of 38.9 ± 0.7 % prior to starting LDB-CPR, rSO2 values at 4, 8 and 12 minutes increased significantly after initiation of LDB-CPR (44.0 ± 0.9 %, 45.2 ± 0.8 %, and 45.5 ± 0.8 %, respectively, p < 0.05). LDB-CPR significantly increased the rSO2 of cardiac arrest patients during resuscitation.