Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial.
Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial.
复制标题
标准的心肺复苏与主动压缩 - 压缩 - 肺肺复苏，增加院外心脏骤停的负面压力：一项随机试验。
DOI：
10.1016/s0140-6736(10)62103-4
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发表时间：
2011-01-22
期刊：
影响因子：
168.9
通讯作者：
Lurie, Keith G.
中科院分区：
文献类型：
--
作者：
Aufderheide, Tom P.;Frascone, Ralph J.;Wayne, Marvin A.;Mahoney, Brian D.;Swor, Robert A.;Domeier, Robert M.;Olinger, Michael L.;Holcomb, Richard G.;Tupper, David E.;Yannopoulos, Demetris;Lurie, Keith G.
与标准CPR相比，主动加压减压心肺复苏术（ACD-CPR）加上CPR减压阶段胸内压的降低先前已被证明可改善血流动力学。我们假设，与标准CPR相比，这些干预措施将提高院外心脏骤停（OOHCA）后的存活率，并具有良好的神经功能。这项前瞻性、随机、开放、设盲、多中心试验评价了ACD-CPR加胸内负压增强的安全性和有效性，在非创伤性OOHCA患者中使用阻抗阈值装置（干预）与标准CPR（对照）进行比较。主要终点是出院时的生存率，神经功能良好，定义为改良兰金量表（mRS）≤3分。符合最终选择标准（非创伤性心脏骤停，假定心脏病因）的患者纳入主要意向治疗分析。在2470例临时入组的患者中，817/2470例（33%）不符合预定的最终选择标准，1653/2470例（67%）符合预定的最终选择标准。标准CPR组（n=813）和干预组（n=840）之间的患者临床特征无显著差异。对照组中mRS ≤3的出院生存率为5.8%（47/813），干预组为8.9%（75/840）[p=0.019，OR 1.58（CI= 1.07，2.36）]。总体而言，更多患者在干预后存活至1年：74/840（8.8%）vs 48/813（5.9%）（p=0.03），两组的认知技能、残疾评级和生活质量指数相似。两组之间的总体主要不良事件发生率（次要安全性终点）无显著差异，但干预组中有一个类别（肺水肿）较高：11.2%（94/840）vs 6.7%（62/813），p=0.015。与标准CPR相比，ACD-CPR治疗增加胸内负压导致出院存活率显著增加，神经功能良好。OOHCA后一年，干预组的生存率显著较高，两组幸存者的神经功能恢复相似。
Active compression decompression cardiopulmonary resuscitation (ACD-CPR) plus a decrease in intrathoracic pressure during the decompression phase of CPR have been shown previously to result in improved hemodynamics when compared with standard CPR. We hypothesized that these interventions would increase survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OOHCA) when compared with standard CPR. This prospective, randomized, open, blinded, multicenter trial evaluated the safety and effectiveness of ACD-CPR plus augmentation of negative intrathoracic pressure, achieved with an impedance threshold device (intervention), compared with standard CPR (control) in patients with non-traumatic OOHCA. The primary endpoint was survival to hospital discharge with favorable neurologic function, defined as a modified Rankin Scale (mRS) ≤3. Patients meeting final selection criteria (non-traumatic arrest, presumed cardiac etiology) were included in the primary intention-to-treat analysis. Of the 2470 provisionally enrolled patients, 817/2470 (33%) did not meet and 1653/2470 (67%) met the pre-specified final selection criteria. There were no significant differences in patient clinical profiles between the standard CPR (n=813) and the intervention (n=840) groups. Survival to hospital discharge with a mRS ≤3 was 5.8% (47/813) in the control group versus 8.9% (75/840) in the intervention group [p=0.019, OR 1.58 (CI= 1.07, 2.36)]. Overall, more patients survived to one year with intervention: 74/840 (8.8%) versus 48/813 (5.9%) (p=0.03), with similar cognitive skills, disability ratings, and quality of life indices in both groups. The overall major adverse event rate (secondary safety endpoint) was not significantly different between groups, but one category, pulmonary edema, was higher in the intervention group: 11.2% (94/840) versus 6.7% (62/813), p=0.015. Compared with standard CPR, treatment with ACD-CPR with augmentation of negative intrathoracic pressure resulted in significantly increased survival to hospital discharge with favorable neurological function. One year after OOHCA, survival was significantly higher in the intervention group and there was a similar restoration of neurologic function in survivors in both groups.