Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest.
Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest.
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DOI：
10.1161/circulationaha.110.010736
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发表时间：
2011-07-05
期刊：
影响因子：
37.8
通讯作者：
Resuscitation Outcomes Consortium (ROC) Investigators
中科院分区：
文献类型：
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作者：
Cheskes S;Schmicker RH;Christenson J;Salcido DD;Rea T;Powell J;Edelson DP;Sell R;May S;Menegazzi JJ;Van Ottingham L;Olsufka M;Pennington S;Simonini J;Berg RA;Stiell I;Idris A;Bigham B;Morrison L;Resuscitation Outcomes Consortium (ROC) Investigators
围休克期暂停是在呼吸性休克之前和之后胸部按压的暂停。我们研究了休克期停顿与出院存活率之间的关系。我们纳入了复苏结局联盟Epistry-Cardiac Arrest中的院外心脏骤停（OHCA）患者，这些患者在2005年12月至2007年6月期间发生了心脏骤停，表现为可电击心律（室颤或无脉性室性心动过速），并且至少有一次电击的CPR过程数据（n=815）。我们使用多变量逻辑回归来确定存活率和休克期暂停之间的关系。在一项调整Utstein生存预测因子的分析中，休克前暂停≥20秒的患者生存几率显著降低（OR：0.47，95%CI：0.27，0.82）和休克期暂停≥40秒（OR：0.54，95%CI：0.31，0.97）。休克后暂停与生存率的显著变化无关。对数线性模型描述了休克前和休克围期暂停间期每增加5秒（分别高达40秒和50秒），出院时生存率分别降低18%和14%，与休克后暂停间期的变化无显著相关性。在以可电击节律出现心脏骤停的患者中，较长的电击前后暂停时间与出院存活率下降独立相关。电击前暂停对生存的影响表明，改进自动除颤器软件和护理人员教育以最大限度地减少电击前暂停延迟可能会对生存产生重大影响。
Peri-shock pauses are pauses in chest compressions prior to and following defibrillatory shock. We examined the relationship between peri-shock pauses and survival to hospital discharge. We included out-of-hospital cardiac arrest (OHCA) patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) and had CPR process data for at least one shock (n=815). We used multivariable logistic regression to determine the association between survival and peri-shock pauses. In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with pre-shock pause ≥20 seconds (OR: 0.47, 95%CI: 0.27, 0.82) and peri-shock pause ≥40 seconds (OR: 0.54, 95%CI: 0.31, 0.97) when compared to patients with pre-shock pause <10 seconds and peri-shock pause <20 seconds. Post-shock pause was not independently associated with a significant change in the odds of survival. Log linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5 second increase in both pre- and peri-shock pause interval (up to 40 and 50 seconds respectively) with no significant association noted with changes in the post-shock pause interval. In patients with cardiac arrest presenting in a shockable rhythm longer peri-shock and pre-shock pauses were independently associated with a decrease in survival to hospital discharge. The impact of pre-shock pause on survival suggests refinement of automatic defibrillator software and paramedic education to minimize pre-shock pause delays may have significant impact on survival.