在非医院心脏骤停期间静脉注射药物:一个随机试验
Theresa M Olasveengen1, Kjetil Sunde, Cathrine Brunborg
1Institute for Experimental Medical Research, Oslo University Hospital, Ullevaal, N-0407 Oslo, Norway. t.m.olasveengen@medisin.uio.no
JAMA
|November 26, 2009
概括
将静脉注射药物从高级心脏生命支持 (ACLS) 协议中删除,并没有改善外院心脏骤停患者在医院出院后的存活率. 这项研究发现,群体之间的生存率或心肺复苏质量没有显著差异.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 关键的护理关键的护理
背景情况:
- 目前的高级心脏生命支持 (ACLS) 准则包括静脉注射 (IV) 接入和药物管理,尽管对改善结果的证据有限.
- 在心肺复苏 (CPR) 期间使用上腺素与不良结果有关,可能是由于毒性或CPR中断.
研究的目的:
- 调查是否从ACLS协议中省略了IV药物给药,影响了医院外心脏骤停 (OHCA) 患者的存活到出院的时间.
主要方法:
- 一项前性随机对照试验,涉及挪威奥斯陆的OHCA成年患者 (2003-2008).
- 患者接受了标准ACLS与IV药物管理或ACLS没有IV药物接入.
- 主要结局是存活到出院;次要结局包括1年的存活率,神经结果,自发循环的恢复和CPR质量.
主要成果:
- 在IV药物治疗组 (10.5%) 和非IV治疗组 (9.2%) 之间,在存活到出院的时间没有显著差异.
- 没有IV的组显示出自发循环回归率显著更高 (32%对21%).
- 在两组中,心肺复苏质量相似,符合指导方针建议;在长期生存或有利的神经结果方面没有发现显著差异.
结论:
- 与没有IV药物的协议相比,在OHCA的ACLS中,静脉输入和药物给药并没有导致存活到出院的统计学上显著的改善,CPR质量或长期存活.
- 在IV组中观察到更高的短期生存率,但这并没有转化为更好的长期结果.
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