儿童有组织节律的胸部压缩:血液动力学和结果分析
Shairbanu S Zinna1, Ryan W Morgan1, Ron W Reeder2
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Resuscitation
|December 5, 2023
概括
儿童心肺复苏 (CPR) 准则建议在心率 (HRs) 低于60次每分钟 (bpm) 且输液不良的情况下开始进行心肺复苏. 在CPR前的脉压≥20 mmHg与改善的患者结局有关,包括恢复自发循环和在医院出院后的存活率,以及有利的神经结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 儿科急救医学 儿科急救医学
- 心血管生理学心血管生理学
背景情况:
- 目前的儿科心肺复苏 (CPR) 准则建议在心率 (HR) 低于60次每分钟 (bpm),伴随着 poor perfusion 的情况下启动心肺复苏.
- 在指导复苏工作方面,区分带有不良 perfusion (BRADY) 的胸和无脉动电活动 (PEA) 是至关重要的.
研究的目的:
- 为了比较儿童患者与BRADY和PEA之间的CPR前心率 (HR) 和动脉血压 (BP).
- 调查CPR前血液动力学参数与患者结果之间的关联,包括自发循环恢复 (ROSC) 和存活率.
主要方法:
- 一项前性观察队列研究,分析了ICU-RESUScitation试验中的数据.
- 血液动力学数据 (HR,BP) 在心肺复苏前15秒和2分钟内收集,按年龄分层 (≤1岁和>1岁).
- 使用波桑回归模型来评估CPR前血液动力学与结果之间的关系.
主要成果:
- 在两年龄层中,与PEA组相比,在BRADY组中,CPR前HR显著较低.
- 在CPR前的脉压在BRADY组比PEA组更高.
- 在CPR前的脉压≥20 mmHg与PEA患者的ROSC率更高,以及在BRADY和PEA组中改善了在医院出院后的存活率,并具有有利的神经结果.
结论:
- 进行心肺复苏前的脉压,特别是≥20 mmHg,是与接受心肺复苏的儿科患者改善结果相关的有价值指标.
- 虽然CPR前HR在BRADY和PEA之间有所不同,但<60bpm的门值与结果没有独立相关.
- 对脉压的临床评估可能有助于在儿科心肺复苏前和期间的风险分层和治疗决策.
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