公众AED治疗院外心脏骤停的再颤动与电击抵抗性室颤发生率
本研究回顾性分析1459例由非专业施救者使用公众AED治疗的院外心脏骤停患者的心电数据。再颤动发生率为34.1%，中位再颤动时间为29.8秒。在231例连续三次电击的患者中，电击抵抗性室颤仅11例（4.8%）。
要点
- 非专业施救者AED治疗时再颤动发生率低于BLS/ALS报告的水平
- 再颤动通常发生在成功电击后30秒内
- 2分钟CPR周期可能导致再颤动患者延迟约1.5分钟才接受下一次电击
核心结论
- 非专业施救者使用公众AED治疗OHCA时，再颤动发生率低于BLS/ALS治疗的报告水平。
- 再颤动通常发生在成功电击后的前30秒内，提示2分钟CPR周期可能导致再颤动患者延迟约1.5分钟才接受下一次电击。
研究设计与样本
- 回顾性分析由非专业施救者使用公众AED治疗的OHCA患者的心电数据。
- 两名研究者独立判读心律、电击成功与否、再颤动、再颤动时间及电击抵抗性室颤。
- 共纳入1459例至少接受一次电击且数据可用的患者。
主要发现
- 再颤动发生于498例（34.1%）患者。
- 每例患者再颤动中位次数为1次（IQR 1, 2）。
- 中位再颤动时间为29.8秒。
- 231例（15.8%）患者观察到连续三次电击。
- 11例（占231例的4.8%）患者存在电击抵抗性室颤。
关键数值与推荐
- 电击抵抗性室颤定义为连续三次电击均失败。
- 再颤动发生率为34.1%（498/1459）。
- 连续三次电击发生率为15.8%（231/1459）。
- 电击抵抗性室颤占连续三次电击患者的4.8%（11/231）。
- 中位再颤动时间为29.8秒。
临床怎么用
- 对需要多次电击的OHCA患者，应关注成功电击后前30秒内的再颤动风险。
- 2分钟CPR周期下再颤动患者可能延迟约1.5分钟才接受下一次电击，需研究最佳CPR时长。
- 非专业施救者使用AED时，应重视连续三次电击失败患者的识别与后续处理策略的差异。
局限性
- 回顾性研究设计，无法排除混杂因素。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Background Out-of-hospital cardiac arrest (OHCA) treatment often requires multiple defibrillatory shocks due to failed defibrillation or refibrillation. The complete nature of refractory ventricular fibrillation (VF) is unknown, as many studies do not consider shocks delivered by lay rescuers prior to the arrival of basic life support (BLS)/advanced life support (ALS) when quantifying refractory VF. ERC guidelines define refractory VF as continuous VF after three consecutive shocks, not differentiating between patients who refibrillate and those with shock-resistant VF (three consecutive failed shocks) which may contribute to this variation in reported incidence. There are some differences in treatment recommendations for patients who refibrillate and those with shock-resistant VF. Therefore, understanding the number of shocks delivered by lay-rescuers with public access defibrillators (PADs) and the patient’s response to them prior to BLS/ALS arrival may inform treatment strategies. Methods ECG data collected retrospectively from OHCAs treated by lay-rescuers using PADs were analysed. Cardiac rhythm, shock success, refibrillation, time to refibrillation and presence of shock-resistant VF (three consecutive failed shocks) were determined by two investigators. Results Data were available for 1459 patients receiving at least one shock. Refibrillation occurred in 498 (34.1%) patients. The median number of refibrillations per patient was 1 (IQR 1, 2). Median time to refibrillation was 29.8 s. Three consecutive shocks were observed in 231 of the 1459 (15.8%) patients, 11 patients (4.8% of 231 patients) had shock-resistant VF. Conclusion When treated by lay-rescuers with PADs, refibrillation occurrence is lower than that reported for patients treated by BLS/ALS. However, aligned with BLS/ALS studies, in lay-rescuer treated OHCA, refibrillation typically occurs within the first 30 s following a successful shock. Therefore, patients who refibrillate are typically in VF for an additional 1.5 min before receiving a subsequent shock for PADs with a 2 min cardiopulmonary resuscitation (CPR) cycle. This finding emphasises the need for investigation into optimal CPR duration for patients requiring multiple shocks.
引用
- Open Heart：Incidence of refibrillation and shock-resistant ventricular fibrillation during OHCA when treated with a public access defibrillator: implications for CPR timing in lay rescuer-treated OHCA
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。