CC:机械与人工心肺复苏术(CPR):当代系统综述和更多的综述

Abstract

Background：High‐quality cardiopulmonary resuscitation (CPR) can restore spontaneous circulation (ROSC) and neurological function and save lives. We conducted an umbrella review, including previously published systematic reviews (SRs), that compared mechanical and manual CPR; after that, we performed a new SR of the original studies that were not included after the last published SR to provide a panoramic view of the existing evidence on the effectiveness of CPR methods. 高质量的心肺复苏（CPR）可以恢复自主循环（ROSC）和神经功能，挽救生命。我们进行了一项伞状综述，包括之前发表的系统综述（SRs），比较了机械CPR和手动CPR；之后，我们对上次发表的SR之后未包括的原始研究进行了新的SR，以提供对CPR方法有效性的现有证据的全景视图。

Methods：PubMed, EMBASE, and Medline were searched, including English in‐hospital (IHCA) and out‐of‐hospital cardiac arrest (OHCA) SRs, and comparing mechanical versus manual CPR. A Measurement Tool to Assess Systematic Reviews (AMSTAR‐2) and GRADE were used to assess the quality of included SRs/studies. We included both IHCA and OHCA, which compared mechanical and manual CPR. We analyzed at least one of the outcomes of interest, including ROSC, survival to hospital admission, survival to hospital discharge, 30‐day survival, and survival to hospital discharge with good neurological function. Furthermore, subgroup analyses were performed for age, gender, initial rhythm, arrest location, and type of CPR devices. 检索了PubMed、EMBASE和Medline，包括英语的院内心脏骤停（IHCA）和院外心脏骤停（OHCA）SRs，并比较了机械与手动CPR。使用评估系统综述的测量工具（AMSTAR-2）和GRADE评估了纳入的SRs/研究的质量。我们包括了比较机械和手动CPR的IHCA和OHCA。我们分析了至少一个感兴趣的结果，包括ROSC、住院生存、出院生存、30天生存以及出院时具有良好神经功能的生存。此外，还进行了年龄、性别、初始心律、骤停地点和CPR设备类型的亚组分析。

Results：We identified 249 potentially relevant records, of which 238 were excluded. Eleven SRs were analyzed in the Umbrella review (January 2014–March 2022). Furthermore, for a new, additional SR, we identified eight eligible studies (not included in any prior SR) for an in‐depth analysis between April 1, 2021, and February 15, 2024. The higher chances of using mechanical CPR for male patients were significantly observed in three studies. Two studies showed that younger patients received more mechanical treatment than older patients. However, studies did not comment on the outcomes based on the patient’s gender or age. Most SRs and studies were of low to moderate quality. The pooled findings did not show the superiority of mechanical compared to manual CPR except in a few selected subgroups. 我们确定了249条可能相关的记录，其中238条被排除。在伞状综述中分析了11项SRs（2014年1月至2022年3月）。此外，对于一项新的、额外的SR，我们确定了8项符合条件的研究（未包含在任何先前的SR中），在2021年4月1日至2024年2月15日之间进行了深入分析。在三项研究中显著观察到男性患者使用机械CPR的几率更高。两项研究表明，年轻患者比老年患者接受了更多的机械治疗。然而，研究没有根据患者的性别或年龄对结果进行评论。大多数SRs和研究的质量为低至中等。综合发现并没有显示出机械CPR相比手动CPR的优越性，除了少数选定的亚组。

Conclusions：Given the significant heterogeneity and methodological limitations of the included studies and SRs, our findings do not provide definitive evidence to support the superiority of mechanical CPR over manual CPR. However, mechanical CPR can serve better where high‐quality manual CPR cannot be performed in selected situations.鉴于纳入的研究和SRs的显著异质性和方法学限制，我们的发现没有提供明确的证据来支持机械CPR优于手动CPR。然而，在选定情况下，如果无法进行高质量的手动CPR，机械CPR可以更好地发挥作用。