院前心脏骤停患者心肺复苏时由第一目击者使用自动体外除颤器的优势Meta分析

Superiority of cardiopulmonary resuscitation plus automated external defibrillator used by first - responders on patients with out -of- hospital cardiac arrests： a meta -analysis

目的 评价第一目击者在医护急救人员（emergency medical service, EMS）到来之前对院前心脏骤停（out-of-hospital cardiac arrest, OHCA）患者进行心肺复苏（cardiopulmonary resuscitation, CPR）时是否使用自动体外除颤器（automated external defibrillator, AED）对复苏结局的影响。方法 计算机检索在国内外各大数据库公开发表的关于院前心脏骤停患者是否早期使用AED进行CPR的临床队列研究，并对获得文献进行严格的筛选,按照Cochrane Handbook5.1.0质量评价标准评价纳入文献质量并提取有效数据，应用RevMan5.3软件分别对三个结局指标（存活至出院、存活至入院、自主循环恢复）进行Meta分析。结果 纳入10个研究，共计9478例患者，其中由第一目击者应用AED的CPR（CPR＋AED）组3014人，第一目击者未应用AED的CPR（CPR-Only）组6464人。Meta分析结果显示：CPR＋AED相比CPR-Only而言可以提高院前心脏骤停患者的出院生存率，差异有统计学意义（RR=1.48，95%CI 1.35～1.63，P＜0.00001）。在纳入的10项研究中，5项报道了入院存活率，Meta分析结果同样表明：CPR＋AED相比CPR-Only对于提高成年心脏骤停患者的入院生存率也具有一些优势，差异有统计学意义（RR=1.24，95%CI 1.12～1.37，P＜0.0001）。3项研究报道了ROSC，而Meta分析结果表明CPR＋AED与CPR-Only改善患者自主循环恢复（restoration of spontaneous circulation,ROSC）比较差异无统计学意义（RR=1.09，95%CI 1.00～1.19，P=0.05）。结论 在提高院前心脏骤停患者的出院生存率和入院生存率方面，由第一目击者使用自动体外除颤器的CPR效果优于未使用自动体外除颤器或在医护人员到场之后才进行除颤的心肺复苏。

Objective To perform a meta - analysis of the pooled effect of the included studies comparing the outcome of the patients receiving cardiopulmonary resuscitation （CPR） plus automated external defibrillator （AED） therapy （ CPR ＋ AED） vs. CPR alone （ CPR - Only）, both delivered by first- responders who witness the out - of - hospital cardiac arrest （OHCA） before the emergency medical service （EMS） arrives. Methods We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Three analyses were planned to assess the outcomes of interest （survival to hospital admission; survival to hospital discharge and return of spontaneous circulation）. Data were elaborated with the software RevmanS. 3. Results Ten studies（9748 patients）were selected for the meta- analysis. The meta- analysis evidenced a statistical difference between the CPR ＋ AED and the CPR - Only in survival to hospital discharge （ RR = 1.48, 95% CI 1.35 - 1.63, P 〈 0. 00001 ）. The analysis also showed a statistical difference between CPR ＋ AED and CPR - Only in survival to hospital admission （RR = 1.24, 95 % CI 1.12 - 1.37, P 〈 0. 0001 ）. However, there was no significant difference between the two groups in return of spontaneous circulation （ROSC） （RR=1.09,95%CI1.00~1.19, P=0.05）. Conclusion The resuhs of our metaanalysis demonstrate that CPR plus early defibrillation with AEDs by first -responders offers a survival advantage over CPR alone or CPR with defibrillation by the EMS in OHCA.