在儿童中进行CPR时间20分钟以上并非无用
2013-01-27 20:58:52   来源：37度医学网   作者：  评论：0 点击：

PITTSBURGH, Pennsylvania — More children than expected survive cardiac arrests in the hospital following prolonged resuscitation, new research shows [1]. The study--the largest to date in this field--"should help dispel common perceptions that cardiopulmonary resuscitation [CPR] is futile beyond 20 minutes," say Dr Renée Matos (University of Pittsburgh School of Medicine, PA) and colleagues in their report, published online January 22, 2013 in Circulation.
宾夕法尼亚州匹兹堡——新的研究显示，许多儿童发生心脏骤停在医院进行长时间的复苏后都获救了，且获救儿童的数量远比预期要多。这项发表在2013年1月22日Circulation网上的报告是迄今为止在该领域规模最大的研究，Renée Matos博士（美国宾夕法尼亚州匹兹堡大学医学院）和他的同事在报告中提到，“该研究应该有助于改变人们对于超过20分钟的CPR是无效的这一观点的看法。”

They did show, however, that children with certain illnesses seem to respond better to prolonged CPR than others. "We found that surgical-cardiac patients had the best outcomes and trauma patients had the worst at each incremental increase in CPR duration." And CPR duration was inversely associated with survival and neurologic outcome, so "this really drives home the point that rapid, high-quality CPR is important," Matos stressed to heartwire.
然而，他们确实发现患有某些疾病的儿童对延长的CPR反应似乎比其他人要好。“我们发现逐步增加 CPR的持续时间对心脏手术病人来说结果是最好的，但对创伤病人来说结局则是最差的。”而且CPR的持续时间与生存和对神经系统的影响呈负相关，所以“使人理解快速、高质量的CPR是很重要的一点，”Matos在接受heartwire采访时说道。

A similar study in adults, published last year, suggested that extending the duration of resuscitation attempts for in-hospital cardiac arrest could save lives. But it also confirmed that most survivors' return of spontaneous circulation occurs early during resuscitation attempts.
去年发表的一项类似的成人研究提示说，尝试延长院内对心脏骤停的复苏持续时间可以挽救生命。但它也证实，大多数幸存者的自主循环恢复过程发生在早期复苏。

Matos says that while the new findings have implications for in-hospital pediatric care, they do not provide a simple solution for when to discontinue CPR. Further studies are needed to determine whether prolonged resuscitative efforts are warranted in particular groups of patients, such as posttraumatic arrests, she says.
Matos说，虽然这项新发现对于院内小儿护理有提示意义，他们没有提供一个简单的结论说何时停止CPR。确定是否有必要在特定患者群体（如创伤后心脏骤停）中延长复苏仍需进一步研究。

Survival Up to 16% in Some Groups, Even After >35 Minutes CPR
甚至在进行35分钟CPR后，有些群体的生存率达16%

Matos and colleagues examined the effect of CPR duration for pediatric in-hospital cardiac arrest (IHCA) from the AHA Get With the Guidelines--Resuscitation prospective multicenter registry of IHCA. They included 3419 children from 328 US and Canadian sites who suffered an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into five illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma.
根据美国心脏协会（AHA）具有前瞻性的多中心小儿心脏骤停复苏指南，Matos和他的同事研究了院内小儿心脏骤停（IHCA）进行CPR的效果。研究对象囊括了从2000年1月到2009年12月间，发生在美国和加拿大328所医院中的心脏骤停的3419名儿童，他们被分为5个疾病种类，即手术心脏、医学心脏、全科医疗、普通外科和创伤。

They analyzed outcomes after CPR durations of one to 15 minutes, 16 to 35 minutes, and >35 minutes. Outcomes in the first 15 minutes were linear and declined rapidly, so "each minute is critical to achieving both survival and a favorable neurologic outcome," they stress.
他们分析了CPR 1-15分钟、16-35分钟和大于35分钟的结果。结果显示CPR患者的结局/预后在第一个15分钟的时候呈线性迅速下降，所以他们强调“为同时取得生存和神经功能正常，每一分钟都很关键。”

Adjusted probability of survival was 42% for CPR duration of one to 15 minutes and 12% for >35 minutes, although this varied by illness category.
虽然疾病的类别不同，但调整后，CPR持续1-15分钟的生存率为42%，,大于35分钟的生存率为12%。

"The finding that survival after >35 minutes CPR is as high as 16.2% in certain patient groups is novel, considering some studies have found overall survival to be 16%," the researchers point out. "Importantly, this study suggests that some children who would presumably die without CPR survive with a favorable neurologic outcome even after prolonged resuscitation efforts."
“研究结果显示在某些患者中进行大于35分钟的CPR后生存率可高达16.2%，这的确很新奇，考虑到一些研究结果，总体生存率为16%，”研究人员指出，“重要的是，该研究提示一些如果不进行CPR就可能死亡的儿童即使经过延长的心肺复苏也有可能幸存下来并有良好的神经系统预后。”

Surgical-Cardiac Patients Fared the Best, Trauma the Worst
心脏手术患者效果最好，创伤患者效果最差

Surgical-cardiac patients had the best outcomes and trauma patients the worst at each incremental increase in CPR duration: in fact, surgical-cardiac patients had a better probability of survival after 90 minutes of chest compressions than trauma patients after one minute.
逐步增加CPR的持续时间对心脏手术病人来说结果是最好的，但对创伤病人来说结局则是最差的：事实上，对心脏手术病人进行90分钟的心脏按压可能比对创伤病人进行1分钟的按压要获得更高的生存率。

Adjusted OR* for Survival to Hospital Discharge by Patient Illness Category

CPR duration (min)	Surgical cardiac	Medical cardiac	General surgical	General medical	Trauma	p
1–15	3.34	1.63	1.31	1	0.29	<0.0001
16–35	2.00	0.82	1.93	1	0.16	0.0005
36–180	2.13	2.18	1.10	1	0.40	0.0377

*Adjusted model includes: initial pulseless rhythm, age category, weekend, night, extracorporeal membrane oxygenation, calcium administration, sepsis, renal insufficiency, vasoactive infusion during arrest, event location, sodium-bicarbonate administration, prior history of cardiopulmonary arrest, prearrest apnea monitor, prearrest pulse oximeter, and patient hypotension prior to arrest
不同疾病类别患者调整后*出院后的生存率

心肺复苏持续时间（分）	手术心脏	医学心脏	普通外科	全科医疗	创伤	p
1–15	3.34	1.63	1.31	1	0.29	<0.0001
16–35	2.00	0.82	1.93	1	0.16	0.0005
36–180	2.13	2.18	1.10	1	0.40	0.0377

调整后的模型包括：最初无脉搏节奏，年龄类别，周末，夜晚，体外膜肺氧合，钙的管理，败血症，肾功能不全，静脉输液过程中停搏，事件发生位置，碳酸氢钠的管理，心跳呼吸骤停既往史，原发性呼吸暂停监护，原发性脉搏血氧饱和度的监测和患者停搏前的低血压。

Among survivors, favorable neurologic outcomes (pediatric cerebral performance category of 1, 2, or 3) occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes.
在幸存者中，70%经历小于15分钟的CPR和60%经历大于35分钟的CPR患者得到了良好的神经功能（小儿脑功能种类1,2,3）

Adjusted ORafor Favorable Neurologic Outcomes at Hospital Discharge by Patient Illness Category

CPR duration (min)	Surgical cardiac	Medical cardiac	General surgical	General medical	Trauma	p
1–15	2.92	1.29	1.03	1	0.21	<0.0001
16–35	2.20	1.05	1.96	1	0.12	0.004
36–180	3.74	3.21	1.30	1	--b	0.0175

a. Adjusted model includes: initial pulseless rhythm, age category, weekend, night, extracorporeal membrane oxygenation, calcium administration, sepsis, renal insufficiency, vasoactive infusion during arrest, event location, sodium-bicarbonate administration, prior history of cardiopulmonary arrest, prearrest apnea monitor, prearrest pulse oximeter, and patient hypotension prior to arrest
b. Too few cases to report (three of 65 had a favorable neurologic outcome in trauma category）
不同疾病类别病人调整后a出院后的神经系统功能

心肺复苏持续时间（分）	手术心脏	医学心脏	普通外科	全科医疗	创伤	p
1–15	2.92	1.29	1.03	1	0.21	<0.0001
16–35	2.20	1.05	1.96	1	0.12	0.004
36–180	3.74	3.21	1.30	1	--b	0.0175

a.调整后的模型包括：最初无脉搏节奏，年龄类别，周末，夜晚，体外膜肺氧合，钙的管理，败血症，肾功能不全，静脉输液过程中停搏，事件发生位置，碳酸氢钠的管理，心跳呼吸骤停既往史，原发性呼吸暂停监护，原发性脉搏血氧饱和度的监测和患者停搏前的低血压。
b.病例过少而不能得出结果（在创伤类别中，65个患者中只有3个获良好神经功能）