当前位置: X-MOL 学术Resuscitation › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival
Resuscitation ( IF 6.5 ) Pub Date : 2022-08-04 , DOI: 10.1016/j.resuscitation.2022.07.039
Johanna C Moore 1 , Paul E Pepe 2 , Kenneth A Scheppke 3 , Charles Lick 4 , Sue Duval 5 , Joseph Holley 6 , Bayert Salverda 7 , Michael Jacobs 8 , Paul Nystrom 9 , Ryan Quinn 10 , Paul J Adams 11 , Mack Hutchison 12 , Charles Mason 12 , Eduardo Martinez 11 , Steven Mason 11 , Armando Clift 11 , Peter M Antevy 3 , Charles Coyle 3 , Eric Grizzard 13 , Sebastian Garay 3 , Remle P Crowe 14 , Keith G Lurie 1 , Guillaume P Debaty 15 , José Labarère 16
Affiliation  

Background

Survival after out-of-hospital cardiac arrest (OHCA) remains poor. A physiologically distinct cardiopulmonary resuscitation (CPR) strategy consisting of (1) active compression-decompression CPR and/or automated CPR, (2) an impedance threshold device, and (3) automated controlled elevation of the head and thorax (ACE) has been shown to improve neurological survival significantly versus conventional (C) CPR in animal models. This resuscitation device combination, termed ACE-CPR, is now used clinically.

Objectives

To assess the probability of OHCA survival to hospital discharge after ACE-CPR versus C-CPR.

Methods

As part of a prospective registry study, 227 ACE-CPR OHCA patients were enrolled 04/2019–07/2020 from 6 pre-hospital systems in the United States. Individual C-CPR patient data (n = 5196) were obtained from three large published OHCA randomized controlled trials from high-performing pre-hospital systems. The primary study outcome was survival to hospital discharge. Secondary endpoints included return of spontaneous circulation (ROSC) and favorable neurological survival. Propensity-score matching with a 1:4 ratio was performed to account for imbalances in baseline characteristics.

Results

Irrespective of initial rhythm, ACE-CPR (n = 222) was associated with higher adjusted odds ratios (OR) of survival to hospital discharge relative to C-CPR (n = 860), when initiated in <11 min (3.28, 95 % confidence interval [CI], 1.55–6.92) and < 8 min (1.88, 95 % CI, 1.03–3.44) after the emergency call, respectively. Rapid use of ACE-CPR was also associated with higher probabilities of ROSC and favorable neurological survival.

Conclusions

Compared with C-CPR controls, rapid initiation of ACE-CPR was associated with a higher likelihood of survival to hospital discharge after OHCA.



中文翻译:

使用循环辅助设备进行心肺复苏期间头部和胸部抬高与提高生存率相关

背景

院外心脏骤停(OHCA)后的生存率仍然很低。一种生理上不同的心肺复苏(CPR)策略,包括(1)主动加压-减压心肺复苏和/或自动心肺复苏,(2)阻抗阈值装置,以及(3)自动控制的头部和胸部抬高(ACE)在动物模型中,与传统 (C) CPR 相比,该方法可显着提高神经系统存活率。这种复苏设备组合被称为 ACE-CPR,现已应用于临床。

目标

评估 ACE-CPR 与 C-CPR 后 OHCA 存活至出院的概率。

方法

作为前瞻性登记研究的一部分,2019 年 4 月至 2020 年 7 月期间,从美国 6 个院前系统招募了 227 名 ACE-CPR OHCA 患者。个体 C-CPR 患者数据 (n = 5196) 是从高性能院前系统的三项大型已发表的 OHCA 随机对照试验中获得的。主要研究结果是出院生存率。次要终点包括自主循环(ROSC)的恢复和良好的神经系统存活。进行 1:4 比例的倾向得分匹配是为了解决基线特征的不平衡问题。

结果

无论初始心律如何,在 <11 分钟内启动时,ACE-CPR (n = 222) 与 C-CPR (n = 860) 相比,出院生存比 (OR) 更高 (3.28, 95%)紧急呼叫后的置信区间 [CI],1.55–6.92)和 < 8 分钟(1.88,95% CI,1.03–3.44)。快速使用 ACE-CPR 还与较高的 ROSC 概率和良好的神经存活率相关。

结论

与 C-CPR 对照相比,快速启动 ACE-CPR 与 OHCA 后存活至出院的可能性较高相关。

更新日期:2022-08-04
down
wechat
bug