除颤和心肺复苏在院外心脏骤停发生时实施先后顺序对复苏成功影响的系统评价和Meta分析

The successful resuscitation effects of the sequence of defibrillation and cardiopulmonary resuscitation on patient with out-of-hospital cardiac arrests:a systematic review and Meta-analysis

目的评价在抢救院外心脏骤停时除颤和心肺复苏(CPR)实施顺序对患者复苏成功的影响。方法计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、维普、中国知识资源总库、万方数据库。纳入所有有关常规抢救方案与除颤前先行CPR比较抢救院外心脏骤停的临床随机对照试验(RCTs),根据Cochrane Handbook4.2.6质量评价标准评价,并用RevMan5.0软件对数据进行Meta分析。结果最终纳入3个研究(668例患者),Meta分析结果显示与常规抢救方案相比,除颤前先行CPR在抢救院外心脏骤停患者出院存活率方面差异无统计学意义(P=0.95);在自主循环恢复(ROSC)方面差异无统计学意义(P=0.43);1年生存率方面差异亦无统计学意义(P=0.49)。亚组分析结果显示在出院存活率和ROSC方面,不论医护人员到达现场时间>5min或≤5min,Meta分析结果显示两组差异均无统计学意义。结论现有临床证据表明,除颤前先行CPR不论医护人员到达现场时间>5min或≤5min,其复苏疗效在出院存活率,ROSC及1年生存率方面与常规抢救方案无差异。由于纳入研究样本量所限,该结论尚需大样本、高质量RCT进一步证实。

Objective To assess the successful resuscitation effects of the sequence of defibrillation and cardiopulmonary resuscitation (CPR) on patient with out-of-hospital cardiac arrests.Methods All randomized controlled trials (RCTs) of standard and CPR first prior to defibrillation for rescuing the out-of-hospital cardiac arrests were retrieved from the databases,including PubMed,EMBASE,Cochrane Library,CBM,VIP,CNKI and Wanfang.We assessed the quality of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.6.The Cochrane Collaboration's software RevMan 5.0 was used for Meta-analysis.Results Three RCTs (668 patients) were included.Meta-analysis showed that there was no significant difference between the standard and the CPR first prior to defibrillation in survival to hospital discharge (P=0.95) and in resumption of spontaneous circulation (ROSC) (P=0.43) or in 1-year survival (P=0.49).In subgroup analysis,for response times of ≤or>5 min,there was no significant difference in survival to hospital discharge and in ROSC.Conclusions The current evidence shows that compared with the standard,CPR first prior to defibrillation offers no advantage in improving outcomes with paramedic response times shorter or longer than 5 minutes.Large studies with high quality will be needed to confirm the successful resuscitation effects of the sequence of defibrillation and CPR on patient with out-of-hospital cardiac arrests.