Resuscitation plus最新文献_第4页

Hand position during chest compression in infantile piglets – Do you need to encircle the chest with the 2-thumb-technique?

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-01-01 DOI: 10.1016/j.resplu.2024.100857

Brandon Kowal , Megan O’Reilly , Tze-Fun Lee , Georg M. Schmölzer

Background

The Pediatric Life Support Consensus on Science With Treatment Recommendations states that chest compressions (CC) be performed with the 2-thumb-encircling and if the chest can not be encircled the 2-finger-technique.

Aim

To compare the hemodynamic effects of four different compression methods during CC in a piglet model of infant asphyxia.

Methods

Nine asphyxiated infant piglets were randomized to CC with 2-thumb-encircling, 2-thumb-, 2-finger-, and one-hand-techniques for one minute at each technique. CC were performed manually while hemodynamic parameters were continuously measured.

Results

Nine infantile piglets (age 5–10 days, weight 2.1–3.0 kg) were included in the study. The 2-thumb-technique and 2-thumb-encircling technique both had a significantly higher mean (SD) ejection fraction of 52.6 (31.2)% and 64.4 (30.6)% compared to the one-hand-technique with 26.6 (15.1)% (p = 0.005). The 2-thumb-encircling technique also had a significantly higher ejection fraction compared to the 2-finger-technique with values of 64.4 (30.6)% and 30.4 (12.1)%, respectively (p = 0.005). Furthermore, 2-thumb-technique and 2-thumb-encircling technique produced significantly higher carotid blood flow and dp/dt_max, and significantly lower dp/dt_min compared to the one-hand- and 2-finger-techniques.

Conclusion

The 2-thumb- and 2-thumb-encircling-techniques produced significantly higher ejection fraction, carotid blood flow, and dp/dt_max, and lower dp/dt_min compared to the 2-finger- and one-hand-techniques. Encircling the chest during the 2-thumb-technique produces similar hemodynamic effects compared to the 2-thumb-technique without encircling.

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引用次数: 0

Effect of vasopressin on brain and cardiac tissue during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets 后叶加压素对新生儿心肺复苏过程中窒息仔猪脑和心脏组织的影响。

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-01-01 DOI: 10.1016/j.resplu.2024.100837

Ali Chaudhry , Megan O’Reilly , Marwa Ramsie , Tze-Fun Lee , Po-Yin Cheung , Georg M. Schmölzer

Background

Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per consensus of science and treatment recommendations. An alternative medication, vasopressin, may be beneficial, however there is limited data regarding its effect on cardiac and brain tissue following recovery from neonatal CPR.

Aim

To compare the effects of vasopressin and epinephrine during resuscitation of asphyxiated post-transitional piglets on cardiac and brain tissue injury.

Methods

Newborn piglets (n = 10/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to hypoxia-asphyxia and cardiac arrest. Piglets were randomly allocated to receive intravenous vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR until return of spontaneous circulation (ROSC). Left ventricle cardiac tissue, and frontoparietal cerebral cortex and thalamus samples from brain tissue were collected from piglets that survived four hours after ROSC. The concentrations of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α, cardiac troponin-1, lactate, and levels of oxidized and total glutathione were quantified in tissue homogenates.

Main Results

The median time (IQR) to ROSC was 127 (98–162)sec with Vaso and 197 (117–480)sec with Epi (p = 0.07). ROSC rate was 10/10 (100 %) with Vaso and 7/10 (70 %) with Epi (p = 0.21); survival to four hours after ROSC was 10/10 (100 %) with Vaso and 5/7 (71 %) with Epi (p = 0.15). Kaplan-Meier survival curves were significantly different between groups (p = 0.011). Cardiac tissue IL-8 concentration was significantly lower with Vaso than Epi (16.9 (2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026). All other markers of cardiac and brain tissue injury were similar between Vaso and Epi groups.

Conclusions

Vasopressin is effective in the resuscitation of asphyxiated newborn piglets and is associated with reduced inflammation of the myocardium compared to epinephrine, and there was no evidence of increased tissue injury in the frontoparietal cortex and thalamus regions of the brain. Vasopressin might be a viable alternative to epinephrine during neonatal CPR, but further studies are warranted.

背景：根据科学和治疗建议的共识，肾上腺素是目前唯一被推荐用于新生儿心肺复苏（CPR）的心脏复苏药物。一种替代药物，抗利尿激素，可能是有益的，然而，关于其对新生儿心肺复苏术恢复后心脏和脑组织的影响的数据有限。目的：比较过渡期窒息仔猪复苏过程中加压素和肾上腺素对心脏和脑组织损伤的影响。方法：新生仔猪（10只/组）麻醉、气管切开、插管、插管、缺氧、窒息、心脏骤停。仔猪在心肺复苏术中随机分配静脉注射抗利尿激素（Vaso, 0.4 U/kg）或肾上腺素（Epi, 0.02 mg/kg），直至恢复自然循环（ROSC）。从ROSC后存活4小时的仔猪的脑组织中采集左心室心脏组织、大脑额顶叶皮层和丘脑样本。测定组织匀浆中促炎细胞因子白介素(IL)-1β、IL-6、IL-8、肿瘤坏死因子(TNF)-α、心肌肌钙蛋白-1、乳酸的浓度以及氧化谷胱甘肽和总谷胱甘肽的水平。主要结果：Vaso组至ROSC的中位时间（IQR）为127 (98-162)sec， Epi组为197 (117-480)sec （p = 0.07）。Vaso组的ROSC率为10/10 (100%)，Epi组为7/10 (70%)(p = 0.21)；Vaso组至ROSC后4小时的生存率为10/10 (100%)，Epi组为5/7 (71%)（p = 0.15）。Kaplan-Meier生存曲线组间差异有统计学意义（p = 0.011）。Vaso组心肌组织IL-8浓度显著低于Epi组(16.9 （2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026）。在Vaso组和Epi组之间，心脏和脑组织损伤的其他指标相似。结论：与肾上腺素相比，加压素对窒息新生仔猪的复苏是有效的，并且与心肌炎症的减少有关，并且没有证据表明大脑额顶叶皮层和丘脑区域的组织损伤增加。加压素可能是新生儿心肺复苏术中肾上腺素的可行替代品，但需要进一步的研究。

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引用次数: 0

Esmolol in persistent ventricular fibrillation/tachycardia with de-emphasised adrenaline - Introducing the REVIVE project. 艾司洛尔治疗持续性室颤/心动过速，去势肾上腺素--REVIVE 项目介绍。

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-15 eCollection Date: 2025-01-01 DOI: 10.1016/j.resplu.2024.100842

Thomas Gleeson-Hammerton, Julian Hannah, John Pike, Matthew Taylor, James Raitt, Peter Owen, David B Sidebottom, Adam Watson, David Jeffery, James Plumb

引用次数: 0

Evaluating video-supported layperson CPR compared to a standard training course: A randomized controlled trial 评估视频支持的外行人CPR与标准培训课程的比较：一项随机对照试验。

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100835

S.A. Goldberg , R.E. Cash , G.A. Peters , D. Jiang , C. O’Brien , M.A. Hasdianda , E,M. Eberl , K.J. Salerno , J. Lees , J. Kaithamattam , J. Tom , A.R. Panchal , E. Goralnick

Background

While just-in-time (JIT) training is associated with time and cost savings, limited evidence directly compares layperson CPR performance using JIT videos to in-person CPR courses. We measured layperson CPR performance using a JIT video compared to an in-person course or no training.

Methods

Adult employees at a professional sports stadium were randomized to perform CPR in a simulated scenario a) after completing an AHA HeartSaver® course, b) using a JIT training video, or c) neither (control). CPR performance was assessed by trained evaluators and QCPR-enabled simulators. The primary outcome was the performance of pre-defined critical actions. Participants were blinded to study objectives and trained evaluators used standardized checklists.

Results

Of 230 eligible subjects, 221 were included in analysis, without significant differences in group characteristics. Correct CPR performance was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28–51; JIT: 15%, 95%CI 8–26; control 10%, 95%CI 4–19). Compression fraction was significantly greater in the AHA group (90%, IQR 69–98) compared to JIT (61%, IQR 29–89) or control (65%, IQR 33–93). An AED was requested more frequently in the AHA group (47%) than in the JIT (15%) or control (10%) groups.

Conclusions

While overall performance of correct CPR skills was best following a traditional CPR course, laypersons using real-time video training performed as well as those taking an AHA HeartSaver® course on several key measures including time to chest compressions and compression rate.

Trial Registration.

NCT05983640.

背景：虽然准时制（JIT）培训与时间和成本节约有关，但有限的证据直接将使用JIT视频的非专业人员CPR表现与现场CPR课程进行比较。我们使用即时视频来衡量外行人的心肺复苏表现，并将其与现场课程或没有培训的人进行比较。方法：专业体育场馆的成年员工在模拟场景中随机进行心肺复苏术a)完成AHA HeartSaver®课程后，b)使用JIT培训视频，或c)两者都不进行（对照组）。心肺复苏术的表现由训练有素的评估员和qcpr启用模拟器进行评估。主要结果是预先定义的关键行动的表现。参与者不知道研究目标，训练有素的评估人员使用标准化清单。结果：在230名符合条件的受试者中，221名纳入分析，各组特征无显著差异。正确CPR表现较低，但AHA组明显较高(AHA: 40%, 95%CI 28-51；Jit: 15%, 95%ci 8-26；对照组10%，95%CI 4-19)。与JIT组（61%,IQR 29-89）或对照组（65%,IQR 33-93）相比，AHA组（90%,IQR 69-98）的压缩分数显著高于JIT组（61%,IQR 29-89）。AHA组使用AED的频率（47%）高于JIT组（15%）或对照组（10%）。结论：虽然传统CPR课程后正确CPR技能的整体表现最好，但使用实时视频培训的外行人在几项关键指标上的表现与参加AHA HeartSaver®课程的人一样，包括胸外按压时间和按压率。Registration.NCT05983640审判。

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引用次数: 0

Oral-Mucosal PCO2 during hemorrhagic shock closely Monitors its time Course, Severity, and reversal outperforming blood lactate measurement 口腔-粘膜二氧化碳分压在失血性休克密切监测其时间、病程、严重程度和逆转优于血乳酸测量

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100814

Armin Razi , Iyad M. Ayoub , Alvin Baetiong , Salvatore Aiello , Moaz Bin Saeed , Martin Pelletier , Cara Joyce , Raúl J. Gazmuri

Introduction

Given the redistribution of blood flow away from non-immediately vital territories during hemorrhagic shock, we investigate whether monitoring the oral mucosal PCO₂ (P_OMCO₂) as a surrogate of splanchnic circulation, could closely recognize the onset, assess severity, and identify reversal of hemorrhagic shock.

Material and methods

The study was performed on six male pigs (38.4 ± 1.6 kg). P_OMCO₂ was measured using a non-invasive sensor clipped to the cheek. Blood was removed over 120 min from the right atrium modeling spontaneous bleeding and reinfused in 20 min observing the animal for 180 min.

Results

A total of 1485 ± 188 ml (i.e., 64.6 ± 9.5 % of the estimated blood volume) was removed inducing severe hemorrhagic shock. P_OMCO₂ closely paralleled the blood volume change (R² = 0.59, p < 0.001) showing an early and steady increase from 86 ± 5 mmHg at baseline to 152 ± 28 mmHg after 120 min. Blood reinfusion reduced the P_OMCO₂ to 138 ± 37 mmHg after 15 min and 97 ± 34 mmHg at the end of 180 min, coincident with the reversal of hemorrhagic shock. Blood lactate less accurately paralleled the blood volume change (R² = 0.14, p < 0.001) showing a slower increase during hemorrhagic shock (from 1.1 ± 0.3 to 4.2 ± 1.8 mmol/l after 120 min) with further increase to 5.2 ± 1.7 mmol/l following blood reinfusion at minute 150 min, remaining at 4.0 ± 1.5 mmol/l by the end of the 180-minute observation period.

Conclusions

P_OMCO₂ monitoring may provide a clinically practical non-invasive indicator of hemorrhagic shock assessing its severity, clinical course, and treatment effect outperforming blood lactate which exhibited a slower and delayed response.

鉴于失血性休克期间血流从非立即重要部位重新分布，我们研究了监测口腔黏膜PCO2 （POMCO2）作为内脏循环的替代品，是否可以密切识别失血性休克的发病，评估严重程度，并识别失血性休克的逆转。材料与方法选用6头体重（38.4±1.6 kg）的公猪。使用夹在脸颊上的非侵入性传感器测量POMCO2。大鼠右心房自发出血模型120 min后取血，20 min后再输注，观察180 min。结果共取血1485±188 ml（占估计血容量的64.6±9.5%），引起严重失血性休克。POMCO2与血容量变化密切相关(R2 = 0.59, p <；0.001)，显示早期稳定地从基线时的86±5 mmHg增加到120分钟后的152±28 mmHg。血液回流使POMCO2在15分钟后降至138±37 mmHg，在180分钟结束时降至97±34 mmHg，与失血性休克的逆转一致。血乳酸浓度与血容量变化的相关性较差(R2 = 0.14, p <；0.001)，在失血性休克期间升高较慢（120分钟后从1.1±0.3升至4.2±1.8 mmol/l）， 150分钟后再输血后进一步升高至5.2±1.7 mmol/l， 180分钟观察期结束时保持在4.0±1.5 mmol/l。结论spoomco2监测可作为临床实用的无创性失血性休克严重程度、病程及治疗效果评估指标，优于血乳酸反应较慢且延迟的失血性休克监测指标。

{"title":"Oral-Mucosal PCO2 during hemorrhagic shock closely Monitors its time Course, Severity, and reversal outperforming blood lactate measurement","authors":"Armin Razi , Iyad M. Ayoub , Alvin Baetiong , Salvatore Aiello , Moaz Bin Saeed , Martin Pelletier , Cara Joyce , Raúl J. Gazmuri","doi":"10.1016/j.resplu.2024.100814","DOIUrl":"10.1016/j.resplu.2024.100814","url":null,"abstract":"<div><h3>Introduction</h3><div>Given the redistribution of blood flow away from non-immediately vital territories during hemorrhagic shock, we investigate whether monitoring the oral mucosal PCO<sub>2</sub> (P<sub>OM</sub>CO<sub>2</sub>) as a surrogate of splanchnic circulation, could closely recognize the onset, assess severity, and identify reversal of hemorrhagic shock.</div></div><div><h3>Material and methods</h3><div>The study was performed on six male pigs (38.4 ± 1.6 kg). P<sub>OM</sub>CO<sub>2</sub> was measured using a non-invasive sensor clipped to the cheek. Blood was removed over 120 min from the right atrium modeling spontaneous bleeding and reinfused in 20 min observing the animal for 180 min.</div></div><div><h3>Results</h3><div>A total of 1485 ± 188 ml (i.e., 64.6 ± 9.5 % of the estimated blood volume) was removed inducing severe hemorrhagic shock. P<sub>OM</sub>CO<sub>2</sub> closely paralleled the blood volume change (R<sup>2</sup> = 0.59, p < 0.001) showing an early and steady increase from 86 ± 5 mmHg at baseline to 152 ± 28 mmHg after 120 min. Blood reinfusion reduced the P<sub>OM</sub>CO<sub>2</sub> to 138 ± 37 mmHg after 15 min and 97 ± 34 mmHg at the end of 180 min, coincident with the reversal of hemorrhagic shock. Blood lactate less accurately paralleled the blood volume change (R<sup>2</sup> = 0.14, p < 0.001) showing a slower increase during hemorrhagic shock (from 1.1 ± 0.3 to 4.2 ± 1.8 mmol/l after 120 min) with further increase to 5.2 ± 1.7 mmol/l following blood reinfusion at minute 150 min, remaining at 4.0 ± 1.5 mmol/l by the end of the 180-minute observation period.</div></div><div><h3>Conclusions</h3><div>P<sub>OM</sub>CO<sub>2</sub> monitoring may provide a clinically practical non-invasive indicator of hemorrhagic shock assessing its severity, clinical course, and treatment effect outperforming blood lactate which exhibited a slower and delayed response.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100814"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Locked vs. unlocked AED cabinets: The Western Australian perspective on improving accessibility and outcomes

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100807

Matthew Didcoe , Caitlyn Pavey-Smith , Judith Finn , Jason Belcher

引用次数: 0

Patient selection and early withdrawal of life support in extracorporeal cardiopulmonary resuscitation (ECPR): Do we have a problem?

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100735

Eduard Argudo, María Martínez-Martínez, María Vidal-Burdeus, Pau Torrella, Jordi Riera

引用次数: 0

Hypoxic hepatitis in survivors of cardiac arrest: A systematic review and meta-analysis 心脏骤停幸存者的缺氧性肝炎：系统回顾和荟萃分析。

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100834

Ya-Bei Gao , Jia-Heng Shi , Da-Xing Yu , Hui-Bin Huang

Background

Hypoxic hepatitis (HH) is commonly seen in critically ill patients, such as those with cardiac shock, sepsis, and respiratory failure. However, data are limited regarding its impact on the prognosis of patients with cardiac arrest (CA).

Methods

We conducted a systematic review and meta-analysis of studies from PubMed, EMBASE, and the Cochrane Library from inception to July 30, 2024. Studies were included if they focused on adult CA patients with HH compared to controls and had a clear definition of HH (defined as a rapid elevation in liver enzyme levels > 20 times the upper limit of normal after CA). The primary outcome was all-cause mortality.

Subgroup analyses, sensitivity analyses, and generic inverse variance analyses were conducted.

Results

Six studies with 3,005 adults were included. The median prevalence of HH was 16.3 % (ranging from 7.2 to 24.7 %). Overall, patients with HH had a significantly higher risk of all-cause mortality than those without (odds ratio [OR] = 3.49; 95 % CI, 2.19–5.57; P < 0.00001). This finding was confirmed in subgroups, sensitivity analyses, and regression analyses. HH patients were more likely to have a poor neurological outcome (OR = 2.73; 95 % CI, 1.37–5.42; P = 0.004), post-CA shock (OR = 5.77; 95 % CI, 1.76–18.94; P = 0.004), cardiac failure (OR = 35.84; 95 % CI, 6.02–213.31; P < 0.0001), and higher lactate levels (mean difference [MD] = 4.10 mmol/L; 95 % CI, 2.89–5.31; P < 0.00001). In addition, HH required more continuous renal replacement therapy (OR = 4.19; 95 % CI, 3.02–5.82; P < 0.00001), vasopressor therapy, time to return of spontaneous circulation (MD = 5.0 min; 95 % CI, 3.02–6.97; P < 0.00001) but not mechanical ventilation (OR = 1.40; 95 % CI, 1.00–1.97; P = 0.05).

Conclusions

Hypoxic hepatitis is not a rare complication after CA, and was independently associated with all-cause mortality. Further prospective, well-designed studies are needed to validate our findings.

背景：缺氧性肝炎（HH）常见于危重患者，如心源性休克、败血症和呼吸衰竭。然而，关于其对心脏骤停（CA）患者预后影响的数据有限。方法：我们对PubMed、EMBASE和Cochrane图书馆从成立到2024年7月30日的研究进行了系统回顾和荟萃分析。如果研究的重点是与对照组相比HH的成年CA患者，并且HH的定义明确（定义为CA后肝酶水平快速升高bbb20倍于正常上限），则纳入研究。主要结局为全因死亡率。进行亚组分析、敏感性分析和一般逆方差分析。结果：纳入了6项涉及3,005名成人的研究。HH的中位患病率为16.3%（范围从7.2%到24.7%）。总体而言，HH患者的全因死亡风险显著高于无HH患者(优势比[OR] = 3.49；95% ci, 2.19-5.57；P = 0.004)， ca后休克(OR = 5.77；95% ci, 1.76-18.94；P = 0.004)，心力衰竭(OR = 35.84；95% ci, 6.02-213.31；p p p p = 0.05)。结论：缺氧性肝炎不是CA后的罕见并发症，并且与全因死亡率独立相关。需要进一步的前瞻性、精心设计的研究来验证我们的发现。

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引用次数: 0

Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study 院外心脏骤停的环甲膜切开术：观察性研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-26 DOI: 10.1016/j.resplu.2024.100833

Matthew Humar , Benjamin Meadley , Bart Cresswell , Emily Nehme , Christopher Groombridge , David Anderson , Ziad Nehme

Aim

To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.

Methods

Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.

Results

We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02–1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16–0.51) and needle techniques (OR 0.11, 95 % CI 0.02–0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00–50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %).

Conclusion

We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.

目的描述接受环甲膜切开术的院外心脏骤停（OHCA）患者的发病率、特征、成功率和预后。方法在 18 年间，我们回顾性分析了环甲膜切开术病例的患者护理记录和心脏骤停登记数据。结果我们发现了 80 例环甲膜切开术，其中 56 例发生在 OHCA 患者中。环甲膜切开术在 OHCA 中的发生率为每 1,000 例复苏尝试中有 1.1 例，且在研究期间有所上升（发生率比 [IRR] = 1.13，95% 置信区间 [CI]：1.02-1.25，P＜0.05）：1.02-1.25, p = 0.023).总体成功率为 68.8%（n = 55/80），心脏骤停患者的成功率（n = 33/56，58.9%）低于非心脏骤停患者（n = 22/24，91.7%）。在 OHCA 患者中，手术成功率高于针刺技术（88.2% 对 54.6%，P = 0.003）。心脏骤停（几率比 [OR] 0.09，95 % CI 0.16-0.51）和针刺技术（OR 0.11，95 % CI 0.02-0.56）与手术成功几率较低独立相关，而男性（OR 10.06，95 % CI 2.00-50.62）与手术成功几率较高相关。自发循环恢复率为44.6%（n=22/56），其中35.7%（n=20/56）存活至住院，7.1%（n=4/56）存活至出院。手术并发症包括心脏骤停（n = 6/56，10.7%）、轻微出血（n = 5/56，8.9%）、手术气肿（n = 3/56，5.4%）和大出血（n = 2/56，3.6%）。需要进一步研究来评估环甲膜切开术在心脏骤停中的作用和潜在益处。

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引用次数: 0

Does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review 对非心脏骤停患者进行胸外按压会造成意外伤害吗？系统回顾

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-23 DOI: 10.1016/j.resplu.2024.100828

Frances Williamson , Pek Jen Heng , Masashi Okubo , Abel Martinez Mejias , Wei-Tien Chang , Matthew Douma , Jestin Carlson , James Raitt , Therese Djärv

Background

Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required.

Aim

To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes.

Method

We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764).

Results

From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (<1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision.

Conclusion

Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.

背景胸外按压在心脏骤停时可挽救生命，但非专业人员担心会对非心脏骤停患者造成意外伤害，这可能会限制胸外按压的提供，从而延误在需要时启动胸外按压。目的对证据进行系统性回顾，以确定在医院外的非心脏骤停患者中，与不使用胸外按压相比，由非专业人员提供胸外按压是否会恶化结果。方法我们检索了 Medline (Ovid)、Web of Science Core Collection (clarivate) 和 Cinahl (Ebsco)。结果包括出院时或 30 天内神经/功能结果良好的存活率；意外伤害（如肋骨骨折、出血）；伤害风险（如吸入）。采用 ROBINS-I 评估偏倚风险。采用 "建议、评估、发展和评价分级 "方法确定证据的确定性。(PROSPERO注册号：CRD42023476764）。结果从筛选出的7832篇参考文献中，纳入了五项观察性研究，共计1031名患者。没有直接因胸外按压导致死亡的报道，但有 61 例（6%）患者在出院前因潜在疾病死亡。共有 9 人（占 1%）受伤，包括肋骨骨折和不同程度的内出血，24 人（占 2%）报告了胸痛等症状。由于存在偏倚和不精确的风险，证据的确定性很低。结论最初由非专业人员进行胸外按压、后经专业医护人员确定未发生心脏骤停的患者很少因胸外按压而受伤。

{"title":"Does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review","authors":"Frances Williamson , Pek Jen Heng , Masashi Okubo , Abel Martinez Mejias , Wei-Tien Chang , Matthew Douma , Jestin Carlson , James Raitt , Therese Djärv","doi":"10.1016/j.resplu.2024.100828","DOIUrl":"10.1016/j.resplu.2024.100828","url":null,"abstract":"<div><h3>Background</h3><div>Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required.</div></div><div><h3>Aim</h3><div>To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes.</div></div><div><h3>Method</h3><div>We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764).</div></div><div><h3>Results</h3><div>From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (<1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision.</div></div><div><h3>Conclusion</h3><div>Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100828"},"PeriodicalIF":2.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0