上腺素剂量间隔与儿科住院心脏骤停结果有关:一个多中心研究
Martha F Kienzle1, Ryan W Morgan1, Ron W Reeder2
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
Critical care medicine
|June 4, 2024
概括
在儿科心肺复苏 (CPR) 期间缩短上腺素剂量间隔并没有改善神经生存率,但确实增加了自发循环 (ROSC) 的持续恢复,并缩短了重症儿童的CPR持续时间.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 复苏科学复苏科学 复苏科学
- 儿童心脏病学 儿童心脏病学
背景情况:
- 关于心肺复苏 (CPR) 期间上腺素最佳剂量间隔的数据存在矛盾.
- 了解这些间隔对于改善儿科心脏骤停的结果至关重要.
研究的目的:
- 评估上腺素剂量间隔与儿科心脏骤停患者结果之间的关联.
- 为了测试这样的假设,即剂量间隔小于3分钟,与大于或等于3分钟的间隔相比,可以提高神经生存率.
主要方法:
- 对ICU-RESUScitation项目的二次分析,这是一项多中心试验,涉及18个儿科重症监护室 (PICU) 和儿科心脏ICU.
- 包括的受试者年龄在18岁或以下,心脏骤停指数,不包括那些服用不到两剂上腺素,体外心肺复苏或间隔>8分钟的人.
- 主要暴露是上腺素剂量间隔:3分钟与≥3分钟.
主要成果:
- 在382名符合条件的患者中,较短的上腺素间隔 (<3分钟) 并没有与改善的存活率至出院与有利的神经结果相关 (aRR 1.10;P=0.48).
- 然而,较短的间隔与自发循环持续恢复 (ROSC) 的改善有关 (aRR 1.21;P<0.01).
- 较短的上腺素剂量间隔也与显著较短的心肺复苏持续时间相关 (估计效果-9.5分钟;P<0.01).
结论:
- 在接受至少两剂上腺素的儿科患者中,<3分钟的间隔没有改善神经学结果.
- 较短的上腺素剂量间隔与持续的ROSC增加和CPR持续时间减少有关.
- 进一步的研究可能会澄清儿科心肺复苏治疗的上腺素最佳策略.
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