通气与否？心肺复苏的新策略

doi:10.3969/j.issn.1006-7795.2015.03.031

摘要/Abstract

摘要：

心肺复苏的新策略已经在成人和儿童心肺复苏中倡导"C-A-B"的复苏顺序,即按压-气道-呼吸的复苏顺序.很多研究表明,人工通气并不像以往想象的那么重要.本文对大量最新的心肺复苏研究结论做一综述,其中也包括中国同行的研究成果.

Abstract:

New strategy of CPR has been raised and the "C-A-B" (chest compression, airway, and breathing) sequence has been advocated for adults and pediatric patients. Many studies demonstrate that the rescue breathing not so important as previously thought. In this review, we summarize many studies, including Chinese scholars', to elaborate this problem.

Key words: cardiopulmonary resuscitation, rescue breathing, cardiocerebral resuscitation

中图分类号:

R459.7

王烁, 李春盛. 通气与否？心肺复苏的新策略[J]. 首都医科大学学报, 2015, 36(3): 491-496.

Wang Shuo, Li Chunsheng. Ventilation or not? New strategies on cardiopulmonary resuscitation[J]. Journal of Capital Medical University, 2015, 36(3): 491-496.

参考文献

[1] Safar P, Brown T C, Holtey W J, et al. Ventilation and circulation with closed-chest cardiac massage in man[J]. JAMA, 1961, 176: 574-576.
[2] Berg R A, Hemphill R, Abella B S, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation,2010, 122(Suppl 3): 685-705.
[3] 成俊芬, 骆永文. 两种心肺复苏顺序抢救未被目击心搏骤停患者效果的比较[J]. 中国急救医学,2002, 22(9): 532.
[4] 陆长东, 朱松杰, 熊远青,等. 溺水儿童非传统顺序心肺复苏成功的原因探讨[J]. 中华急诊医学杂志,2004, 13(9): 625-627.
[5] Wang S, Li C, Ji X, et al. Effect of continuous compressions and 30:2 cardiopulmonary resuscitation on global ventilation/perfusion values during resuscitation in a porcine model[J]. Crit Care Med,2010, 38(10): 2024-2030.
[6] Kern K B, Hilwig W, Berg R B, et al. Importance of continuous chest compression during cardiopulmonary resuscitation, improved outcome during a simulated single lay-rescuer scenario[J]. Circulation,2002, 105(5): 645-649.
[7] Noc M, Weil M H, Tang W, et al. Mechanical ventilation may not be essential for initial cardiopulmonary resuscitation[J]. Chest 1995, 108(3): 821-827.
[8] Berg R A, Kern K B, Hilwig R W, et al. Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation[J]. Circulation, 1997, 95(6): 1635-1641.
[9] Deakin C D, O'Neill J F, Tabor T. Does compression-only cardiopulmonary resuscitation generate adequate passive ventilation during cardiac arrest? [J].Resuscitation,2007, 75(1): 53-59.
[10] Noc M, Weil M H, Sun S, et al. Spontaneous gasping during cardiopulmonary resuscitation without mechanical ventilation[J]. Am J Respir Crit Care Med, 1994, 150(3): 861-864.
[11] Yang L, Weil M H, Noc M, et al. Spontaneous gasping increases the ability to resuscitate during experimental cardiopulmonary resuscitation[J]. Crit Care Med,1994, 22(5): 879-883.
[12] Clark J J, Larsen M P, Culley L L, et al. Incidence of agonal respirations in sudden cardiac arrest[J]. Ann Emerg Med,1992, 21(12): 1464-1467.
[13] Menegazzi J J, Check B D. Spontaneous agonal respiration in a swine model of out-of-hospital cardiac arrest[J]. Acad Emerg Med,1995, 2(12): 1053-1056.
[14] Wang S, Wu J Y, Guo Z J, et al. Effect of rescue breathing during cardiopulmonary resuscitation on lung function after restoration of spontaneous circulation in a porcine model of prolonged cardiac arrest[J]. Crit Care Med,2013, 41(1): 102-110.
[15] Berg R A, Kern K B, Hilwig R W, et al. Assisted ventilation during ‘bystander’ CPR in a swine acute myocardial infarction model does not improve outcome[J]. Circulation, 1997, 96(12): 4364-4371.
[16] Dorph E, Wik L, Stromme T A, et al. Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs[J]. Resuscitation,2004, 60(3): 309-318.
[17] SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study[J]. Lancet,2007, 369(9565): 920-926.
[18] Holmberg M, Holmberg S, Herlitz J. Factors modifying the effect of bystander ardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden[J]. Eur Heart J,2001, 22(6): 511-519.
[19] Waalewijn R A, Tijssen J G, Koster R W. Bystander initiated actions in out-of hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST) [J]. Resuscitation,2001, 50(3): 273-279.
[20] Van Hoeyweghen R J, Bossaert L L, Mullie A, et al. Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group[J]. Resuscitation, 1993, 26(1): 47-52.
[21] Nolan J P, Hazinski M F, Steen P A, et al. Controversial topics from the 2005 International Consensus Conference on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Resuscitation,2005, 67(2-3): 175-179.
[22] [JP+1] Ewy G A. Cardiocerebral resuscitation: a better approach to cardiac arrest[J]. Curr Opin Cardiol,2008, 23(6): 579-584.
[23] Ewy G A. A new approach for out-of-hospital CPR: a bold step forward[J]. Resuscitation,2003, 58(3): 271-272.
[24] Kern K B. Limiting interruptions of chest compressions during cardiopulmonary resuscitation[J]. Resuscitation,2003, 58(3): 273-274.
[25] Hayes M M, Ewy G A, Anavy N D, et al. Continuous passive oxygen insufflation results in a similar outcome to positive pressure ventilation in a swine model of out-of-hospital ventricular fibrillation[J]. Resuscitation,2007, 74(2): 357-365.
[26] Bobrow B J, Clark L L, Ewy G A, et al. Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest[J]. JAMA,2008, 299(10): 1158-1165.
[27] Iwami T, Kawamura T, Hiraide A, et al. Effectiveness of bystander initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest[J]. Circulation,2007, 116(25): 2900-2907.
[28] Berg R A, Sanders A B, Kern KB, et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest[J]. Circulation,2001, 104(20): 2465-2470.
[29] Ong M E, Ng F S, Anushia P, et al. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore[J]. Resuscitation,2008, 78(2): 119-126.
[30] Sanders A B, Kern K B, Berg R A, et al. Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios[J]. Ann Emerg Med,2002, 40(6): 553-562.
[31] Ewy G A. Cardiocerebral resuscitation: the new cardiopulmonary resuscitation[J]. Circulation,2005, 111(16): 2134-2142.
[32] Paradis N A, Martin G B, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation[J]. JAMA, 1990, 263(8): 1106-1113.
[33] Aufderheide T P, Sigurdsson G, Pirrallo R G, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation[J]. Circulation,2004, 109(16): 1960-1965.
[34] Wang S, Li C S, Wu J Y, et al. Relationship between intrathoracic pressure and hemodynamics during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest[J]. Chin Med J: Engl,2012, 125(20): 3606-3611.
[35] Kitamura T, Iwami T, Kawamura T, et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population based cohort study[J]. Lancet,2010, 375(9723): 1347-1354.
[36] Kitamura T, Iwami T, Kawamura T, et al. Bystander-initiated rescue breathing for out of-hospital cardiac arrests of noncardiac origin[J]. Circulation,2010, 122(3): 293-299.
[37] Herlitz J, Engdahl J, Svensson L, et al. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden[J]. Am Heart J,2005, 149(1): 61-66.
[38] Ewy G A. Cardiocerebral resuscitation should replace cardiopulmonary resuscitation for out-of-hospital cardiac arrest[J]. Curr Opin Crit Care,2006, 12(3): 189-192.
[39] Ewy G A, Kern K B, Sanders A B, et al. Cardiocerebral resuscitation for cardiac arrest[J]. Am J Med,2006, 119(1): 6-9.
[40] Ewy G A, Zuercher M, Hilwig R W, et al. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest[J]. Circulation,2007, 116(22): 2525-2530.
[41] Kellum M J, Kennedy K W, Ewy G A. Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest[J]. Am J Med,2006, 119(4): 335-340.
[42] Guo Z J, Li C S, Yin W P, et al. Comparison of shock-first strategy and cardiopulmonary resuscitation-first strategy in a porcine model of prolonged cardiac arrest[J]. Resuscitation,2013, 84(2): 233-238.
[43] Wang Y L, Zhong J Q, Tao W, et al. Initial defibrillation versus initial chest compression in a 4-minute ventricular fibrillation canine model of cardiac arrest[J]. Crit Care Med,2009, 37(7): 2250-2252.
[44] Wik L, Steen P A, Bircher N G. Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest[J]. Resuscitation,1994, 28(3): 195-203.
[45] Gallagher E J, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest[J]. JAMA,1995, 274(24): 1922-1925.
[46] Wu J Y, Li C S, Liu Z Y, et al. A comparison of two types of chest compressions in a porcine model of cardiac arrest[J]. Am J Emerg Med,2009, 27(7): 823-829.
[47] Sayre M R, Berg R A, Cave D M, et al. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee[J]. Circulation,2008, 117(16): 2162-2167.
[48] Pell J P, Sirel J M, Marsden A K, et al. Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology[J]. Heart,2003, 89(8): 839-842.
[49] Herlitz J, Engdahl J, Svensson L, et al. Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden[J]. Resuscitation,2005, 64(1): 37-40.
[50] Brennan R T, Braslow A. Skill mastery in public CPR classes[J]. Am J Emerg Med,1998, 16(7): 653-657.