目的:评估聚焦超声心动图的个体使用和预测价值,潮气末二氧化碳(EtCO2),儿童心肺复苏(CPR)期间的有创动脉血压(BP)和近红外光谱(NIRS)。
方法:本范围审查是作为国际复苏联络委员会(ILCOR)持续证据评估过程的一部分,并基于系统审查和荟萃分析(PRISMA)范围审查的首选报告项目。PubMed,MEDLINE,从最新的ILCOR评论中搜索CINAHL和EMBASE,直到2020年9月。我们纳入了所有发表的评估超声心动图效果的研究,EtCO2,BP或NIRS指导CPR对临床结果和CPR质量的影响。
结果:我们确定了8项观察性研究,包括288名儿童。两个病例系列报告了超声心动图的使用,一个是检测肺栓塞,第二个心脏停滞,使用体外膜氧合可以恢复收缩力。描述EtCO2的两项研究在平均值与任何结果之间的关联方面存在矛盾。平均舒张压与生存率增加和良好的神经系统预后相关。但在两项描述重叠人群的研究中没有新的实质性发病率。NIRS值反映了两项研究中EtCO2和脑血容量指数的变化,在未实现循环恢复的患者中,该值较低。
结论:尽管这些停滞内变量似乎有一些有益的影响,需要更高质量的儿科研究来评估超声心动图,EtCO2,BP或NIRS指导的CPR可以改善结果。
OBJECTIVE: To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO2), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children.
METHODS: This scoping
review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. PubMed, MEDLINE, CINAHL and EMBASE were searched from the last ILCOR reviews until September 2020. We included all published studies evaluating the effect of echocardiography, EtCO2, BP or NIRS guided CPR on clinical outcomes and quality of CPR.
RESULTS: We identified eight observational studies, including 288 children. Two case series reported the use of echocardiography, one in detecting pulmonary emboli, the second in cardiac standstill, where contractility was regained with the use of extracorporeal membrane oxygenation. The two studies describing EtCO2 were ambivalent regarding the association between mean values and any outcomes. Mean diastolic BP was associated with increased survival and favourable neurological outcome, but not with new substantive morbidity in two studies describing an overlapping population. NIRS values reflected changes in EtCO2 and cerebral blood volume index in two studies, with lower values in patients who did not achieve return of circulation.
CONCLUSIONS: Although there seems some beneficial effect of these intra-arrest variables, higher quality paediatric studies are needed to evaluate whether echocardiography, EtCO2, BP or NIRS guided CPR could improve outcomes.