心搏骤停患者垂直空间院前转运过程中机械心肺复苏效果分析--一项历史性队列研究

Effects of mechanical cardiopulmonary resuscitation during vertical spatial pre-hospital transport in patients with cardiac arrest:a historical cohort study

目的分析心搏骤停患者垂直空间院前急救转运过程中机械心肺复苏(CPR)救治效果。方法采用历史性队列研究方法,收集2019年7月至2021年6月经湖州市急救中心转运至湖州市中心医院急诊医学科就诊的102例院外心搏骤停(OHCA)患者的临床资料,其中2019年7月至2020年6月在院前转运过程中实施人工胸外按压的患者作为对照组,2020年7月至2021年6月在院前转运过程中实施人工-机械胸外按压(先实施人工胸外按压,待机械胸外按压装置准备就绪后立即实施机械胸外按压)的患者作为观察组。记录两组患者性别、年龄等基本资料,以及院前急救过程评价指标〔胸外按压比例(CCF)、总CPR暂停时间、院前转运时间、垂直空间转运时间〕和院内高级复苏效果评价指标〔初始呼气末二氧化碳分压(P_(ET)CO_(2))、自主循环恢复(ROSC)率、ROSC时间〕。结果最终共84例患者纳入分析,其中对照组46例,观察组38例。两组患者性别、年龄、是否接受旁观者CPR、初始心律、院前急救响应耗时、发病时所在楼层、预估垂直高度、转运过程中有无垂直转运电梯或扶梯等基本资料差异均无统计学意义。在院前急救效果评价方面,观察组患者院前急救过程中的CCF较对照组显著升高〔69.05%(67.35%,71.73%)比61.88%(58.18%,65.04%),P<0.01〕,总CPR暂停时间较对照组显著缩短〔s:266(214,307)比332(257,374),P<0.05〕;但观察组院前转运时间和垂直空间转运时间与对照组比较差异无统计学意义〔院前转运时间(min):14.50(12.00,16.75)比14.00(11.00,16.00),垂直空间转运时间(s):32.15±17.43比27.96±18.67,均P>0.05〕。说明机械CPR可以提高院前急救过程中的CPR质量,且并未影响院前急救医务人员对患者的转运。在院内高级复苏效果评价方面,观察组患者初始P_(ET)CO_(2)较对照组明显升高〔mmHg(1 mmHg≈0.133 kPa):15.00(13.25,16.00)比12.00(11.00,13.00),P<0.01〕,ROSC时间较对照组明显缩短(min:11.00±3.25比16.64±2.54,P<0.01),ROSC率较对照组略有升高(31.58%比23.91%,P>0.05)。说明转运途中持续机械按压有助于保障持续高质量CPR。结论机械胸外按压可以提高OHCA患者院前转运过程中的持续CPR质量,改善患者初期复苏结局。

Objective To analyze the effect of mechanical cardiopulmonary resuscitation(CPR)on patients with cardiac arrest with the vertical spatial pre-hospital emergency transport.Methods A retrospective cohort study was conducted.The clinical data of 102 patients with out-of-hospital cardiac arrest(OHCA)who were transferred to the emergency medicine department of Huzhou Central Hospital from the Huzhou Emergency Center from July 2019 to June 2021 were collected.Among them,the patients who performed artificial chest compression during the pre-hospital transfer from July 2019 to June 2020 served as the control group,and the patients who performed artificial-mechanical chest compression(implemented artificial chest compression first,and implemented mechanical chest compression immediately after the mechanical chest compression device was ready)during pre-hospital transfer from July 2020 to June 2021 served as the observation group.The clinical data of patients of the two groups were collected,including basic data(gender,age,etc.),pre-hospital emergency process evaluation indicators[chest compression fraction(CCF),total CPR pause time,pre-hospital transfer time,vertical spatial transfer time],and in-hospital advanced resuscitation effect evaluation indicators[initial end-expiratory partial pressure of carbon dioxide(P_(ET)CO_(2)),rate of restoration of spontaneous circulation(ROSC),time of ROSC].Results Finally,a total of 84 patients were enrolled,including 46 patients in the control group and 38 in the observation group.There was no significant difference in gender,age,whether to accept bystander resuscitation or not,initial cardiac rhythm,time-consuming pre-hospital emergency response,floor location at the time of onset,estimated vertical height,and whether there was any vertical transfer elevator/escalator,etc.between the two groups.In the evaluation of the pre-hospital emergency process,the CCF during the pre-hospital emergency treatment of patients in the observation group was significantly higher than that in the control group[69.05%(67.35%,71.73%)vs.61.88%(58.18%,65.04%),P<0.01],the total pause time of CPR was significantly shorter than that in the control group[s:266(214,307)vs.332(257,374),P<0.05].However,there was no significant difference in the pre-hospital transfer time and vertical spatial transfer time between the observation group and the control group[pre-hospital transfer time(minutes):14.50(12.00,16.75)vs.14.00(11.00,16.00),vertical spatial transfer time(s):32.15±17.43 vs.27.96±18.67,both P>0.05].It indicated that mechanical CPR could improve the CPR quality in the process of pre-hospital first aid,and did not affect the transfer of patients by pre-hospital emergency medical personnel.In the evaluation of the in-hospital advanced resuscitation effect,the initial P_(ET)CO_(2) of the patients in the observation group was significantly higher than that of the patients in the control group[mmHg(1 mmHg≈0.133 kPa):15.00(13.25,16.00)vs.12.00(11.00,13.00),P<0.01],the time of ROSC was significantly shorter than that in the control group(minutes:11.00±3.25 vs.16.64±2.54,P<0.01),and the rate of ROSC was slightly higher than that in the control group(31.58%vs.23.91%,P>0.05).It indicated that continuous mechanical compression during pre-hospital transfer helped to ensure continuous high-quality CPR Conclusion Mechanical chest compression can improve the quality of continuous CPR during the pre-hospital transfer of patients with OHCA,and improve the initial resuscitation outcome of patients.