Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation - A randomized trial
Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation - A randomized trial
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DOI：
10.1001/jama.289.11.1389
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发表时间：
2003-03-19
影响因子：
120.7
通讯作者：
Steen, PA
中科院分区：
文献类型：
--
作者：
Wik, L;Hansen, TB;Steen, PA
背景尽快除颤是室颤患者的标准治疗。一项非随机研究表明，室颤后几分钟，延迟除颤给予心肺复苏（CPR）可能会改善预后。目的确定除颤前CPR对室颤患者预后的影响，反应时间长达或长于5分钟。设计，设置，1998年6月至2001年5月在挪威奥斯陆对200例院外室颤患者进行的随机试验。患者接受标准护理，立即除颤（n = 96）或CPR，在除颤前由救护人员进行3分钟的基本CPR（n = 104）。如果最初的除颤不成功，标准组接受1分钟的CPR，然后再进行额外的除颤尝试，而CPR第一组为3分钟。次要终点为入院自主循环恢复（ROSC）、1年生存率和神经系统结局。一个预先设定的分析检查子组的反应时间要么达到或超过5 minutes.Results，在标准组，14（15%）的96例患者存活出院与23（22%）的104在CPR第一组（P= 0.17）。标准组（56% [58/104]）和CPR第一组（46% [44/96]; P= 0.16）之间的ROSC率没有差异; 1年生存率（分别为20% [21/104]和15% [14/96]; P= 0.30）也没有差异。在亚组分析或救护车响应时间长达5分钟或更短的患者中，CPR第一组（n=40）和标准组（n=41）之间的任何结局变量均无差异。对于反应间期超过5分钟的患者，CPR第一组中更多患者达到ROSC（58% [37/64]）与标准组相比（38% [21/55];比值比[OR]，2.22; 95%置信区间[CI]，1.06-4.63; P= 0.04）;出院生存率（22% [14/64] vs 4% [2/55]; OR，7.42; 95% CI，1.61-34.3; P=.006）; 1年生存率（20% [13/64] vs 4% [2/55]; OR，6.76; 95% CI，1.42-31.4; P=.01）。33（89%）的37例患者谁存活到出院有没有或轻微减少神经系统的状态与groups.Conclusions标准治疗室颤相比，心肺复苏术除颤前第一提供没有优势，在改善结果为整个研究人群或救护车响应时间短于5分钟的患者。然而，室颤和救护车响应间隔超过5分钟的患者在尝试除颤之前先进行CPR的结果更好。这些结果需要在额外的随机试验中确认。
Context Defibrillation as soon as possible is standard treatment for patients with ventricular fibrillation. A nonrandomized study indicates that after a few minutes of ventricular fibrillation, delaying defibrillation to give cardiopulmonary resuscitation (CPR) first might improve the outcome.Objective To determine the effects of CPR before defibrillation on outcome in patients with ventricular fibrillation and with response times either up to or longer than 5 minutes.Design, Setting, and Patients Randomized trial of 200 patients with out-of-hospital ventricular fibrillation in Oslo, Norway, between June 1998 and May 2001. Patients received either standard care with immediate defibrillation (n = 96) or CPR first with 3 minutes of basic CPR by ambulance personnel prior to defibrillation (n = 104). If initial defibrillation was unsuccessful, the standard group received 1 minute of CPR, before additional defibrillation attempts compared with 3 minutes in the CPR first group.Main Outcome Measure Primary end point was survival to hospital discharge. Secondary end points were hospital admission with return of spontaneous circulation (ROSC), 1-year survival, and neurological outcome. A prespecified analysis examined subgroups with response times either up to or longer than 5 minutes.Results In the standard group, 14 (15%) of 96 patients survived to hospital discharge vs 23 (22%) of 104 in the CPR first group (P=.17). There were no differences in ROSC rates between the standard group (56% [58/104]) and the CPR first group (46% [44/96]; P=.16); or in 1-year survival (20% [21/104] and 15% [14/96], respectively ; P=.30). In subgroup analysis or patients with ambulance response times of either up to 5 minutes or shorter, there were no differences in any outcome variables between the CPR first group (n=40) and the standard group (n=41). For patients with response intervals of longer than 5 minutes, more patients achieved ROSC in the CPR first group (58% [37/64]) compared with the standard group (38% [21/55]; odds ratio [OR], 2.22; 95% confidence interval [CI], 1.06-4.63; P=.04); survival to hospital discharge (22% [14/64] vs 4% [2/55]; OR, 7.42; 95% CI, 1.61-34.3; P=.006); and 1-year survival (20% [13/64] vs 4% [2/55]; OR, 6.76; 95% CI, 1.42-31.4; P=.01). Thirty-three (89%) of 37 patients Who survived to hospital discharge had no or minor reductions in neurological status with no difference between the groups.Conclusions Compared with standard care for ventricular fibrillation, CPR first prior to defibrillation offered no advantage in improving outcomes for this entire study population or for patients with ambulance response times shorter than 5 minutes. However, the patients with ventricular fibrillation and ambulance response intervals longer than 5 minutes had better outcomes with CPR first before defibrillation was attempted. These results require confirmation in additional randomized trials.