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IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation Pub Date : 2024-12-12 DOI:10.1016/j.resuscitation.2024.110466

Daniel M Rolston, Daniel Jafari, Ghania Haddad, Xueqi Huang, Alaina Berruti, Kevin Frank, Nicholas Bielawa, Timmy Li, Lance B Becker, Allison L Cohen

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引用次数: 0

摘要

导言：有限的证据支持在胸骨下半部进行胸外按压的指南。成像研究表明，这个位置可能会阻碍血流。我们的主要目的是比较胸骨下半部胸外按压（CC）与胸骨左侧胸外按压时的最高动脉线收缩压（SBP），因为胸骨左侧胸外按压更可能位于左心室。其次，我们还比较了最高潮气末二氧化碳（ETCO2）：我们对成人急诊科（ED）心脏骤停复苏的视频录像进行了回顾性队列研究，试图通过改变CC位置来改善生理参数（SBP、ETCO2）。我们排除了上腹部和胸骨右侧按压。我们分析了四个CC区域：推荐的胸骨下半部；胸骨下半部左侧；左外侧高位；左外侧低位。我们使用线性混合效应模型和多变量混合效应对所有胸骨左侧按压进行了分析，并对人工与机械CC进行了控制：在分析的 24 名患者中，20 人（83.3%）的初始按压部位为胸骨下半部。11 名患者有 28 个胸骨下半部和 32 个胸骨左侧 CC 间隔，并有可用的 SBPs。在混合效应模型中，胸骨左侧 CC 的最小平方均值（LSMean）SBP（108.5 mmHg [95 % CI 88.3-128.8 mmHg]）高于胸骨下半部 CC（66.7 mmHg [95 % CI 46.5-86.9 mmHg]，p 2）。在混合效应模型中，胸骨下半部（20.4 mmHg [95 % CI 16.0-24.9 mmHg]）和胸骨左侧（22.6 mmHg [95 % CI 17.6-27.6 mmHg]，p = 0.300）的 LSMean ETCO2 相似。在控制手动与机械CC的情况下，结果相似：在我们对部分急诊室心脏骤停患者进行的试验性、回顾性、观察性研究中，胸骨左侧胸外按压比胸骨下半部胸外按压的 SBP 高，而 ETCO2 相似。

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Left of sternum compressions are associated with higher systolic blood pressure than lower half of sternum compressions in cardiac arrest.

Introduction: Limited evidence supports guidelines to perform chest compressions at the lower half of the sternum. Imaging studies suggest this location may obstruct blood flow. Our primary aim was to compare the highest arterial line systolic blood pressure (SBP) during lower-half-of-sternum chest compressions (CC) versus those left-of-sternum, where the left ventricle is more likely located. Secondarily, we compared the highest end-tidal CO₂ (ETCO₂).

Methods: We conducted a retrospective cohort study of video-recorded, adult Emergency Department (ED) cardiac arrest resuscitations where changes in CC location were attempted to improve physiologic parameters (SBP, ETCO₂). We excluded epigastric and right-of-sternum compressions. Four CC zones were analyzed: recommended lower-half-of-sternum; left of lower-half-of-sternum; high left lateral; low left lateral. We combined all left-of-sternum compressions for analysis using linear mixed-effects models and multivariable mixed-effects controlling for manual vs. mechanical CCs.

Results: Among 24 patients analyzed, 20 (83.3 %) had initial compressions at the lower-half-of-sternum. 11 patients had 28 lower-half-of-sternum and 32 left-of-sternum CC intervals with available SBPs. In the mixed-effects model, least squares mean (LSMean) SBP was higher with left-of-sternum CCs (108.5 mmHg [95 % CI 88.3-128.8 mmHg]) versus lower-half-of-sternum CCs (66.7 mmHg [95 % CI 46.5-86.9 mmHg], p < 0.001). 18 patients had 44 lower-half-of-sternum and 32 left-of-sternum CC intervals with available ETCO₂. In the mixed-effects model, LSMean ETCO₂ was similar at the lower-half-of-sternum (20.4 mmHg [95 % CI 16.0-24.9 mmHg]) and left-of-sternum (22.6 mmHg [95 % CI 17.6-27.6 mmHg], p = 0.300). Results were similar when controlling for manual vs. mechanical CCs.

Conclusions: In our pilot, retrospective, observational study of select ED cardiac arrest patients, left-of-sternum chest compressions are associated with higher SBP than lower-half-of-sternum compressions, while ETCO₂ was similar.

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来源期刊

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.