Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.
Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.
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院外心脏骤停患者的早期与后期的节奏分析。
DOI：
10.1056/nejmoa1010076
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发表时间：
2011-09-01
期刊：
影响因子：
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通讯作者：
ROC Investigators
中科院分区：
文献类型：
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作者：
Stiell IG;Nichol G;Leroux BG;Rea TD;Ornato JP;Powell J;Christenson J;Callaway CW;Kudenchuk PJ;Aufderheide TP;Idris AH;Daya MR;Wang HE;Morrison LJ;Davis D;Andrusiek D;Stephens S;Cheskes S;Schmicker RH;Fowler R;Vaillancourt C;Hostler D;Zive D;Pirrallo RG;Vilke GM;Sopko G;Weisfeldt M;ROC Investigators
与先前的立即除颤策略不同，美国心脏协会-国际复苏联络委员会2005年的复苏指南建议，紧急医疗服务（EMS）人员可以在第一次分析心律之前提供2分钟的心肺复苏（CPR）。我们比较了短时间CPR和早期分析心律的策略与长时间CPR和延迟分析心律的策略。我们在美国和加拿大的10个复苏结局联盟地点进行了一项针对院外心脏骤停成年人的整群随机试验。在最初的心电图分析之前，早期分析组的患者被分配接受30到60秒的EMS管理的CPR，而后期分析组的患者被分配接受180秒的CPR。主要结局是出院时的生存率，功能状态满意（改良兰金量表评分≤3，0 - 6分，评分越高表明残疾越严重）。我们纳入了9933名患者，其中5290名被分配进行心律早期分析，4643名被分配进行后期分析。后期分析组中共有273例患者（5.9%）和早期分析组中有310例患者（5.9%）符合主要结局标准，聚类调整差异为-0.2个百分点（95%置信区间，-1.1至0.7; P = 0.59）。调整混杂因素后的数据分析以及亚组分析也显示，两个研究组均无生存获益。在院外心脏骤停的患者中，我们发现在第一次分析心律之前，与较长时间相比，短时间内EMS管理的CPR的结局没有差异。（由国家心肺血液研究所等资助; ROC PRMED ClinicalTrials.gov编号，NCT 00394706。）
In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of −0.2 percentage points (95% confidence interval, −1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)