机械联合徒手胸外按压在院内心搏骤停患者心肺复苏中应用效果的Meta分析

Application effects of mechanical chest compression combined with manual chest compression in cardiopulmonary resuscitation for patients with in-hospital cardiac arrest:a Meta-analysis

目的系统评价采用机械联合徒手胸外按压与单纯徒手胸外按压对院内心搏骤停(IHCA)患者心肺复苏(CPR)结局指标的影响.方法以"心脏骤停、心搏骤停、心脏停搏、猝死、人工复苏、人工按压、人工胸外按压、徒手心肺复苏、徒手复苏、徒手按压、徒手胸外按压、徒手、人工、复苏仪、复苏机、复苏器、心肺复苏、LUCAS、Autopulse、Thumper、MSCPR-1A"为检索词,检索从建库开始至2019年3年11日在中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库、中国知网数据库(CNKI)公开发表的和以"heart arrest、cardiac arrest、cardiopulmonary arrest、Cardiopulmonary Resuscitation、Resuscitation、Cardio-Pulmonary Resuscitation、CPR、compression、mechanical、automatic、automated、load distributing band、LBD、Autopulse、LUCAS"为主题词检索从建库开始至2019年3月11日在美国国立医学图书馆(PubMed)、荷兰医学文摘(EMbase)、科学网(Web of Science)、Cochrane图馆等数据库公开发表的机械联合徒手胸外按压在IHCA患者CPR中应用效果的文献.结局指标包括自主循环恢复(ROSC)率、出院存活率、并发症发生率.由2名评价者独立提取文献资料,按照Cochrane偏倚风险评价工具对纳入的随机对照试验(RCTs)进行质量评价,对纳入的观察性研究按照文献质量评估表(NOS)评估文献质量.使用RevMan 5.3软件进行Meta分析,采用漏斗图评估发表偏倚.结果共纳入21篇文献,其中RCT 11篇,观察性研究10篇;共纳入研究对象2005例.Meta分析结果显示:与徒手胸外按压组比较,联合胸外按压组ROSC率和出院存活率均明显升高〔ROSC率:优势比(OR)=2.50,95%可信区间(95%CI)=2.03~3.09,P<0.00001;出院存活率:OR=2.71,95%CI=1.91~3.85,P<0.00001〕;并发症发生率降低(OR=0.30,95%CI=0.13~0.68,P=0.004).漏斗图提示,ROSC无明显发表偏倚;出院存活率、并发症发生率因纳入研究较少,无法评估漏斗图的对称性.结论针对IHCA患者采用联合胸外按压可提高ROSC率及出院存活率,降低并发症发生率.建议在对IHCA患者实施救治时,最好采用联合按压方式,即CA早期立即采用徒手胸外按压,然后尽早更换机械胸外按压装置.

Objective To systematically evaluate the effects of mechanical chest compression(CC)combined with manual CC and single-manual CC on the outcome indexes of cardiopulmonary resuscitation(CPR)for patients with in-hospital cardiac arrest(IHCA).Methods The relevant publicly published literatures about the effects of mechanical CC combined with manual CC and single-manual CC on the outcome of CPR were searched by using the following Chinese keywords for retrieval:"cardiac arrest,asystole,sudden death,artificial recovery,artificial press,artificial CC,unarmed CPR,unarmed resuscitation,unarmed compressions,unarmed chest compressions,unarmed,artificial,resuscitation instrument,resuscitation machine,resuscitator,CPR,LUCAS,Autopulse,Thumper,MSCPR-1A"in databases such as China Biomedical Literature(CBM),VIP,Wanfang,and China National Knowledge Internet(CNKI)from their dates of foundation to March 11,2019,and using the following key words in English"heart arrest,cardiac arrest,cardiopulmonary arrest,Cardiopulmonary Resuscitation,Resuscitation,Cardio-Pulmonary Resuscitation,CPR,compression,mechanical,automatic,automated,load distributing band,LBD,Autopulse,LUCAS"to retrieve all the published articles especially concerning the topics on the application effects of mechanical combined with manual CC for IHCA patients'CPR in the America National Library database(PubMed),Excerpta Medica(EMbase),Web of Science,and Cochrane Library from the establishment of the databases to March 11,2019.The indexes of outcomes included return of spontaneous circulation(ROSC)rate,survival rate after hospital discharge and incidence of complications.The literatures were extracted independently by two reviewers,the qualities of the included randomized controlled trials(RCTs)were evaluated according to the Cochrane bias risk assessment tool,and the qualities of the included observational studies were evaluated according to the literature quality assessment form(NOS).Meta analysis was performed by using RevMan 5.3 software,and publication bias was assessed by using funnel plot.Results Twenty-one studies were enrolled,including 11 RCT articles and 10 observational studies;there were 2005 participants.The results of this Meta-analysis showed that compared with manual CC,the ROSC rate and after discharge survival rate of IHCA patients were obviously higher in combined CC group[ROSC:odds ratio(OR)=2.50,95%confidence interval(95%CI)=2.03-3.09,P<0.00001;discharge survival rate:OR=2.71,95%CI=1.91-3.85,P<0.00001];the incidence of complications of combined CC was lower than that in single manual CC(OR=0.30,95%CI=0.13-0.68,P=0.004).The funnel plots indicated that there was no apparent bias in the ROSC;because the enrolled studies were relatively few,it was difficult to evaluate the symmetrical characteristics of the funnel plots for discharge survival rate and the complication rate.Conclusions For IHCA patients,combined CC can improve ROSC,discharge survival rate,and reduce the occurrence of complications.It is suggested that during the actual rescue of IHCA patients,it is better to use combined CC,that is to say,manual CC should be adopted immediately in the early stage and then replace the mechanical CC device as soon as possible.