在心脏骤停中用于儿科除动力的能量剂量:系统性审查和元分析
Jason Acworth1, Jimena Del Castillo2, Lokesh Kumar Tiwari3
1Emergency Department, Queensland Children's Hospital, Brisbane, Australia, Faculty of Medicine, University of Queensland, Australia.
Resuscitation plus
|June 17, 2025
概括
对于儿科心脏骤停的最佳除能量剂量尚不清楚. 目前的证据表明,初始剂量低于1.5 J/kg或高于2.5 J/kg的结果与可震动节奏的2 J/kg相似.
科学领域:
- 儿科急救医学 儿科急救医学
- 心脏病学 心脏病学
- 复苏科学 复苏科学 复苏科学
背景情况:
- 早期除对于治疗儿科心脏骤停中的震动性心室节律失常 (VF,pVT) 是至关重要的.
- 对于儿童初始和随后的除冲击的最佳能量剂量尚未得到确立.
- 目前的指导方针缺乏关于儿科除能量水平的最终建议.
研究的目的:
- 系统地审查和评估不同初始除能量剂量对婴儿,儿童和青少年因VF或pVT而经历心脏骤停的结果的影响.
- 为了评估较低 (<1.5 J/kg) 或较高 (>2.5 J/kg) 的初始除剂量是否优于标准剂量 (约. 2 J/kg) 的使用量.
主要方法:
- 一个系统的审查是由ILCOR儿科生命支持工作组进行的,前性地注册在PROSPERO.
- 搜索包括PubMed,EMBASE和CENTRAL的临床试验和观察性研究,直到2025年1月1日,重点是儿科心脏除.
- 使用ROBINS-I评估了偏差风险,并使用GRADEpro和RevMan分析了结果 (生存,自发循环的恢复).
主要成果:
- 确定了七项观察性研究,主要涉及医院内心脏骤停.
- 证据的整体确定性被确定为非常低.
- 在初始除剂量<1.5 J/kg,>2.5 J/kg和在儿科心脏骤停中约2 J/kg之间,没有观察到释放或自发循环恢复的存活率的显著差异.
结论:
- 目前的证据表明,初始除剂量<1.5 J/kg或>2.5 J/kg与大约2 J/kg的剂量相比,对于患有VF/pVT的儿科心脏骤停,不会显著改变结果.
- 证据的确定性非常低,这凸显了需要高质量的研究.
- 精心设计的随机对照试验对于最终确定儿科复苏中最佳除能量剂量至关重要.
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