Gasping during cardiac arrest in humans is frequent and associated with improved survival.
Gasping during cardiac arrest in humans is frequent and associated with improved survival.
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DOI：
10.1161/circulationaha.108.799940
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发表时间：
2008-12-09
期刊：
影响因子：
37.8
通讯作者：
Kern KB
中科院分区：
文献类型：
--
作者：
Bobrow BJ;Zuercher M;Ewy GA;Clark L;Chikani V;Donahue D;Sanders AB;Hilwig RW;Berg RA;Kern KB
人类心脏骤停后喘息的发生率和意义是有争议的。采用了两种办法。第一项是对凤凰城消防局区域调度中心文本文件中连续确认的院外心脏骤停进行回顾性分析，以确定崩溃后不久是否存在喘息。第二项研究是对亚利桑那州1218例由紧急医疗系统（EMS）急救报告记录的院外心脏骤停患者进行回顾性分析，以确定与各种EMS到达时间相关的骤停后喘息的发生率。主要结局指标为出院时的生存率。对凤凰城消防局区域调度中心记录的目击和未目击的院外心脏骤停与试图复苏的分析发现，113名被捕患者中有44名（39%）有喘息。一项对1218例EMS参与的、有目击者的院外心脏骤停的分析表明，喘息的存在或不存在与EMS到达时间相关。在EMS到达后停止呼吸的119例患者中有39例（33%），EMS到达时间<7分钟时有73例（20%），EMS到达时间为7 - 9分钟时有50例（14%），EMS到达时间>9分钟时有25例（7%）。191例喘息患者中有54例（28%）存活至出院，1027例无喘息患者中有80例（8%）存活至出院（校正比值比为3.4; 95%置信区间为2.2 ~ 5.2）。在接受旁观者心肺复苏的481例患者中，77例喘息患者中有30例（39%）存活至出院，而404例未喘息患者中只有38例（9%）（校正比值比，5.1; 95%置信区间，2.7至9.4）。喘息或异常呼吸在心脏骤停后很常见，但会随着时间的推移而迅速减少。喘息与生存率增加有关。这些结果表明，认识和喘息的重要性，应教导旁观者和紧急医疗调度员，以便不劝阻他们在适当的时候，从启动迅速复苏的努力。
The incidence and significance of gasping after cardiac arrest in humans are controversial. Two approaches were used. The first was a retrospective analysis of consecutive confirmed out-of-hospital cardiac arrests from the Phoenix Fire Department Regional Dispatch Center text files to determine the presence of gasping soon after collapse. The second was a retrospective analysis of 1218 patients with out-of-hospital cardiac arrests in Arizona documented by emergency medical system (EMS) first-care reports to determine the incidence of gasping after arrest in relation to the various EMS arrival times. The primary outcome measure was survival to hospital discharge. An analysis of the Phoenix Fire Department Regional Dispatch Center records of witnessed and unwitnessed out-of-hospital cardiac arrests with attempted resuscitation found that 44 of 113 (39%) of all arrested patients had gasping. An analysis of 1218 EMS-attended, witnessed, out-of-hospital cardiac arrests demonstrated that the presence or absence of gasping correlated with EMS arrival time. Gasping was present in 39 of 119 patients (33%) who arrested after EMS arrival, in 73 of 363 (20%) when EMS arrival was <7 minutes, in 50 of 360 (14%) when EMS arrival time was 7 to 9 minutes, and in 25 of 338 (7%) when EMS arrival time was >9 minutes. Survival to hospital discharge occurred in 54 of 191 patients (28%) who gasped and in 80 of 1027 (8%) who did not (adjusted odds ratio, 3.4; 95% confidence interval, 2.2 to 5.2). Among the 481 patients who received bystander cardiopulmonary resuscitation, survival to hospital discharge occurred among 30 of 77 patients who gasped (39%) versus only 38 of 404 among those who did not gasp (9%) (adjusted odds ratio, 5.1; 95% confidence interval, 2.7 to 9.4). Gasping or abnormal breathing is common after cardiac arrest but decreases rapidly with time. Gasping is associated with increased survival. These results suggest that the recognition and importance of gasping should be taught to bystanders and emergency medical dispatchers so as not to dissuade them from initiating prompt resuscitation efforts when appropriate.