From laboratory science to six emergency medical services systems: New understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest.
From laboratory science to six emergency medical services systems: New understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest.
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DOI：
10.1097/ccm.0b013e31818a7e56
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发表时间：
2008-11
影响因子：
8.8
通讯作者：
Lurie K
中科院分区：
文献类型：
--
作者：
Aufderheide TP;Alexander C;Lick C;Myers B;Romig L;Vartanian L;Stothert J;McKnite S;Matsuura T;Yannopoulos D;Lurie K
本研究的目的是：1）描述了在心脏骤停的小猪模型中使用阻抗阈值装置（ITD）的CPR期间血液流向大脑的新发现机制，以及2）描述了应用2005年指南中与CPR期间增加循环相关的所有高度推荐的变化（包括ITD的使用）对人类的生存益处，来自美国6个EMS系统的动物研究前瞻性试验，每头仔猪作为其自身对照。人类研究使用历史对照。小猪和院外心脏骤停患者小猪（10-12 kg）在心室颤动6分钟后用活性（n=9）或假（n=9）ITD治疗。根据AHA 2005指南和ITD，对人类进行CPR治疗。仔猪研究的主要终点是颈动脉血流量，从未使用ITD的59 ml/min增加至使用ITD的91 ml/min（p=0.017）。在活动性ITD的情况下，胸部回缩期的气道压力从-0.46 mmHg降至-2.59 mmHg（p=0.0006）。在CPR的减压阶段，颅内压（ICP）下降得更快，程度更大，ITD集团的质量保证数据来自美国的6个EMS系统，为约300万人提供服务。在2005年AHA指南实施后，有920名患者接受了心脏骤停治疗，包括ITD的使用，对照组有1750名患者。两组的人口统计学特征相似。对照组的出院存活率为9.3%，干预组为13.6%。比值比、95%置信区间和p值分别为1.54（1.19，1.99）和P = 0.0008。这一生存优势被赋予了心脏骤停心律室颤患者（28.5%对18.0%，P = 0.0008）。在小猪中使用ITD增加了颈动脉血流量和冠状动脉和脑灌注压，并在CPR的减压阶段以比对照组更快的速率降低了颅内压，导致颅内压处于最低点的持续时间更长。与历史对照组相比，6个EMS系统中接受ITD治疗的患者在院外心脏骤停后的生存率增加了近50%，并重新强调了更多按压、更少通气和完全胸壁回缩。
The purpose of this study is to: 1) describe a newly discovered mechanism of blood flow to the brain during CPR using the impedance threshold device (ITD) in a piglet model of cardiac arrest, and 2) describe the survival benefits in humans of applying all of the highly recommended changes in the 2005 Guidelines related to increasing circulation during CPR, including use of the ITD, from 6 EMS systems in the United States Animal studies prospective trial with each piglet serving as its own control. Historical controls were used for the human studies. Piglet and patients with out-of-hospital cardiac arrest Piglets (10-12 kg) were treated with an active (n=9) or sham (n=9) ITD after 6 minutes of ventricular fibrillation. Humans were treated with CPR per the AHA 2005 Guidelines and the ITD. The primary endpoint in the piglet study was carotid blood flow which increased from 59 ml/min without an ITD to 91 ml/min (p=0.017) with ITD use. Airway pressures during the chest recoil phase decreased from -0.46 mmHg to -2.59 mmHg (p=0.0006) with the active ITD. Intracranial pressure (ICP) decreased more rapidly and to a greater degree during the decompression phase of CPR with the active ITD Conglomerate quality assurance data were analyzed from 6 EMS systems in the United States serving a population of ~3 million people. There were 920 patients treated for cardiac arrest following implementation of the 2005 AHA Guidelines, including ITD use, and 1750 patients in the control group during the year prior to implementation. Demographics were similar between the two groups. Survival to hospital discharge was 9.3 % in the control group versus 13.6 % in the intervention group. The odds ratio, 95% confidence interval, and p values were, 1.54 (1.19, 1.99), and P = 0.0008, respectively. This survival advantage was conferred to patients with a presenting cardiac arrest rhythm of ventricular fibrillation (28.5% vs. 18.0%, P = 0.0008). Use of the ITD in piglets increased carotid blood flow and coronary and cerebral perfusion pressures and reduced intracranial pressure during the decompression phase of CPR at a faster rate than controls, resulting in a greater duration of time when intracranial pressures are at their nadir. Patients in 6 EMS systems treated with the ITD together with the renewed emphasis on more compressions, fewer ventilations, and complete chest wall recoil had a nearly 50% increase in survival rates after out-of-hospital cardiac arrest compared with historical controls.
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影响因子：
37.8
作者：
Aufderheide, TP;Sigurdsson, G;Lurie, KG
通讯作者：
Lurie, KG
影响因子：
120.7
作者：
Cobb, LA;Fahrenbruch, CE;Hallstrom, AP
通讯作者：
Hallstrom, AP
影响因子：
120.7
作者：
Wik, L;Hansen, TB;Steen, PA
通讯作者：
Steen, PA
影响因子：
6.5
作者：
Yannopoulos, D;McKnite, S;Lurie, KG
通讯作者：
Lurie, KG
影响因子：
9.6
作者：
Lurie, KG;Mulligan, KA;Lindner, KH
通讯作者：
Lindner, KH