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2017 AHA心肺复苏指南:儿童基本生命支持和心肺复苏

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2017 AHA心肺复苏指南:儿童基本生命支持和心肺复苏CLINICALSTATEMENTSANDGUIDELINESCirculation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540TBDTBD,2017e1ABSTRACT:ThisfocusedupdatetotheAmericanHeartAssociationguidelinesforcardiopulmonaryresuscitation(CPR)andemergencycardiovascularcarefollowsthePediatricTaskFor...
2017 AHA心肺复苏指南:儿童基本生命支持和心肺复苏
CLINICALSTATEMENTSANDGUIDELINESCirculation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540TBDTBD,2017e1ABSTRACT:ThisfocusedupdatetotheAmericanHeartAssociationguidelinesforcardiopulmonaryresuscitation(CPR)andemergencycardiovascularcarefollowsthePediatricTaskForceoftheInternationalLiaisonCommitteeonResuscitationevidencereview.ItalignswiththeInternationalLiaisonCommitteeonResuscitation’scontinuousevidencereviewprocess,andupdatesarepublishedwhentheInternationalLiaisonCommitteeonResuscitationcompletesaliteraturereviewbasedonnewscience.Thisupdateprovidestheevidencereviewandtreatmentrecommendationforchestcompression–onlyCPRversusCPRusingchestcompressionswithrescuebreathsforchildren<18yearsofage.Fourlargedatabasestudieswereavailableforreview,including2publishedafterthe“2015AmericanHeartAssociationGuidelinesUpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare.”Twodemonstratedworse30-dayoutcomeswithchestcompression–onlyCPRforchildren1through18yearsofage,whereas2studiesdocumentednodifferencebetweenchestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreaths.Whentheresultswereanalyzedforinfants<1yearofage,CPRusingchestcompressionswithrescuebreathswasbetterthannoCPRbutwasnodifferentfromchestcompression–onlyCPRin1study,whereasanotherstudyobservednodifferencesamongchestcompression–onlyCPR,CPRusingchestcompressionswithrescuebreaths,andnoCPR.CPRusingchestcompressionswithrescuebreathsshouldbeprovidedforinfantsandchildrenincardiacarrest.Ifbystandersareunwillingorunabletodeliverrescuebreaths,werecommendthatrescuersprovidechestcompressionsforinfantsandchildren.DianneL.Atkins,MD,FAHA,ChairAllanR.deCaen,MDStuartBerger,MD,FAHARicardoA.Samson,MDStephenM.Schexnayder,MDBennyL.Joyner,Jr,MD,MPHBlairL.Bigham,MD,MScDanaE.Niles,MSJonathanP.Duff,MD,MEdElizabethA.Hunt,MD,MPH,PhDPeterA.Meaney,MD,MPH2017AmericanHeartAssociationFocusedUpdateonPediatricBasicLifeSupportandCardiopulmonaryResuscitationQualityAnUpdatetotheAmericanHeartAssociationGuidelinesforCardio­pulmonaryResuscitationandEmergencyCardiovascularCare©2017AmericanHeartAssociation,Inc.KeyWords:AHAScientificStatements◼adolescent◼cardiopulmonaryresuscitation◼child◼heartarrest◼heartmassage◼infantAHAFOCUSEDUPDATEbyguestonNovember8,2017http://circ.ahajournals.org/DownloadedfromAtkinsetalTBDTBD,2017Circulation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540e2ThisfocusedupdatetotheAmericanHeartAsso-ciationguidelinesforcardiopulmonaryresusci-tation(CPR)andemergencycardiovascularcarefollowsthePediatricTaskForceoftheInternationalLiaisonCommitteeonResuscitation’sevidencereviewpublishedsimultaneouslywiththisupdate.1ItalignswiththeInternationalLiaisonCommitteeonResus-citation’scontinuousevidencereviewprocess,andupdatesarepublishedwhentheInternationalLiai-sonCommitteeonResuscitationcompletesalitera-turereviewbasedonnewscience.Adescriptionoftheevidencereviewprocessisavailableinthe“2017InternationalConsensusonCardiopulmonaryResus-citationandEmergencyCardiovascularCareScienceWithTreatmentRecommendationsSummary,”1andaglossaryoftermsisavailableinthatdocument.TheInternationalLiaisonCommitteeonResuscitation’sGradingofRecommendationsAssessment,Develop-ment,andEvaluationassessmentswereconvertedtotheAmericanCollegeofCardiology/AmericanHeartAssociationClassesofRecommendationsandLevelsofEvidence(Table).2Thisupdateprovidesthesummaryofevidenceandtreatmentrecommendationforchestcompression–onlyCPRversusCPRusingchestcompressionswithrescuebreathsforchildren<18yearsofage.Forthepurposesoftheseguidelines,thefollowingholds:•Infantbasiclifesupportguidelinesapplytoinfantsyoungerthan≈1yearofage.•Childbasiclifesupportguidelinesapplytochildren≈1yearofageuntilpuberty.Forteachingpur-poses,pubertyisdefinedasbreastdevelopmentingirlsandthepresenceofaxillaryhairinboys.•Adultbasiclifesupportguidelinesapplyatandbeyondpuberty.3Allotherrecommendationsandalgorithmspub-lishedinthe“2015AmericanHeartAssociationGuide-linesUpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare”andthe“2010Amer-icanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEmergencyCardiovascularCare”4remaintheofficialrecommendationsoftheAmericanHeartAssociation.COMPONENTSOFHIGH­QUALITYCPR:CHESTCOMPRESSION–ONLYCPRThe“2017InternationalConsensusonCardiopulmonaryResuscitationandEmergencyCardiovascularCareSci-enceWithTreatmentRecommendationsSummary”1ad-dressesthecomparisonofchestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreathsforcardiacarrestininfantsandchildren.Itincludes2ad-ditionalout-of-hospitalcardiacarreststudiespublishedafter2015thatfurtherexpandtheevidencebaseusedtodevelopthe2015guidelinesupdate.Abriefsummaryofeachstudyincludedinthereviewisprovidedbelow.2017SummaryofEvidenceAlargeobservationalstudyfromtheAll-JapanUtsteinRegistry5comparedbystander-administeredchestcom-pression–onlyCPRandCPRusingchestcompressionswithrescuebreathsfrom2005through2007,aperiodwhenguidelinestransitionedfromacompression-to-ventilationratioof15:2to30:2forpostpubertalchil-drenandadults.Favorableneurologicaloutcomeandsurvivalat1monthwereobservedlessfrequentlywithchestcompression–onlyCPR.Whentheresultswerestratifiedbyage,children1through17yearsofagehadworseoutcomeswithchestcompression–onlyCPR,whereasnostatisticaldifferencebetweenchestcom-pression–onlyCPRandCPRusingchestcompressionswithrescuebreathswasobservedininfants<1yearofage.Whenfurtherstratifiedbyarrestcause,therewasnodifferencebetweenchestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreathsinpatientswithapresumedcardiaccause.Asubsequentstudyexamineddispatch-assistedCPRinchildrenusingthesamenationalJapanesedatabasebutwithalatertimeinterval,2008through2010.6CPRusingchestcompressionswithrescuebreathswasgen-erallyofferedbydispatchers,butchestcompression–onlyCPRcouldbeoffereddependingontheskillandknowledgeoftherescuer.Chestcompression–onlyCPRresultedinworse1-monthsurvivalandworse1-monthsurvivalwithfavorableneurologicaloutcomecomparedwithCPRusingchestcompressionswithrescuebreaths.Chestcompression–onlyCPRwasnodifferentfromnoCPR.AlargeobservationalstudyfromtheUS-basedCARESregistry(CardiacArrestRegistrytoEnhanceSur-vival)evaluatedtheassociationofbystanderCPRwithoverallandfavorableneurologicalsurvival.TheCARESregistryisanemergencymedicalservices–based,vol-untarydatasetthatincludesacatchmentareaof90millionpeoplefrom37stateswithintheUnitedStates.Theauthorscomparedbystander-administeredchestcompression–onlyCPRandCPRusingchestcompres-sionswithrescuebreaths.7Thecohortwasanalyzedonthebasisofage:<1or1to18years.Forinfants,CPRusingchestcompressionswithrescuebreathswasbet-terthannoCPRbutwasnodifferentfromchestcom-pression–onlyCPRforfavorableneurologicaloutcome.CPRusingchestcompressionswithrescuebreathshadhighersurvivaltodischargethaneithernoCPRorchestcompression–onlyCPR.Forchildren1to18yearsofage,CPRusingchestcompressionswithrescuebreathswasbetterthannoCPRbutwasnodifferentfromchestcompression–onlyCPRforbothsurvivaltohospitaldis-chargeandfavorableneurologicalstatus.Ofnote,out-byguestonNovember8,2017http://circ.ahajournals.org/DownloadedfromPediatricBLSandCPRQuality:FocusedUpdatetotheAHAGuidelinesforCPRandECCCirculation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540TBDTBD,2017e3CLINICALSTATEMENTSANDGUIDELINEScomeswerestatisticallybetterinbothbystanderCPRstrategiescomparedwithnobystanderCPR,asop-posedtotheKitamuraetal5andGotoetal6reports.ThemostrecentstudyoriginatedfromJapanwiththeuseoftheAll-JapanUtsteinRegistry.Theauthorsdirectlycomparedbystanderchestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreathsinchildren>1yearofagewhohadcardiacar-rest,includingtraumaticarrest,during2011and2012.8Anationaldispatch-assistedinstructionprotocolwasinuse,andCPRguidelinesrecommendedacompression-to-ventilationratioof30:2.Chestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreathswereassociatedwithimprovedsurvivalat1monthandfavorableneurologicalsurvivalat1monthcomparedwithnobystanderCPR.Therewasnodif-Table.ACC/AHARecommendationSystem:ApplyingClassofRecommendationandLevelofEvidencetoClinicalStrategies,Interventions,Treatments,orDiagnosticTestinginPatientCare*(UpdatedAugust2015)byguestonNovember8,2017http://circ.ahajournals.org/DownloadedfromAtkinsetalTBDTBD,2017Circulation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540e4ferencebetweenchestcompression–onlyCPRandCPRusingchestcompressionswithrescuebreaths.2017Recommendations—Updated1.CPRusingchestcompressionswithrescuebreathsshouldbeprovidedforinfantsandchildrenincardiacarrest(ClassI;LevelofEvidenceB-NR).Basedonagrowingevi­dencebasesincethe2015guidelinesupdatepublication,thisrecommendationreinforcesthe2015guideline.2.Ifbystandersareunwillingorunabletodeliverrescuebreaths,werecommendthatrescuersprovidechestcompressionsforinfantsandchildren(ClassI;LevelofEvidenceB-NR).WeweighedthesurvivalbenefitsofCPRusingchestcompressionswithrescuebreathsagainsttheconve-nienceofaligningwiththeadultrecommendationforchestcompression–onlyCPRandconcludedthatthein-crementalbenefitofrescuebreathsjustifiedadifferentrecommendation.FOOTNOTESTheAmericanHeartAssociationmakeseveryefforttoavoidanyactualorpotentialconflictsofinterestthatmayariseasaresultofanoutsiderelationshiporapersonal,profes-sional,orbusinessinterestofamemberofthewritingpanel.Specifically,allmembersofthewritinggrouparerequiredtocompleteandsubmitaDisclosureQuestionnaireshowingallsuchrelationshipsthatmightbeperceivedasrealorpotentialconflictsofinterest.ThisfocusedupdatewasapprovedbytheAmericanHeartAssociationScienceAdvisoryandCoordinatingCom-mitteeonSeptember15,2017,andtheAmericanHeartAs-sociationExecutiveCommitteeonOctober9,2017.Acopyofthedocumentisavailableathttp://professional.heart.org/statementsbyusingeither“SearchforGuidelines&State-ments”orthe“BrowsebyTopic”area.Topurchaseaddi-tionalreprints,call843-216-2533ore-mailkelle.ramsay@wolterskluwer.com.TheAmericanHeartAssociationrequeststhatthisdocu-mentbecitedasfollows:AtkinsDL,deCaenAR,BergerS,SamsonRA,SchexnayderSM,JoynerBLJr,BighamBL,NilesDE,DuffJP,HuntEA,MeaneyPA.2017AmericanHeartAssociationfocusedupdateonpediatricbasiclifesupportandcardiopul-monaryresuscitationquality:anupdatetotheAmericanHeartAssociationguidelinesforcardiopulmonaryresuscitationandemergencycardiovascularcare.Circulation.2017;136:eXXX–eXXX.doi:10.1161/CIR.0000000000000540.ExpertpeerreviewofAHAScientificStatementsisconductedbytheAHAOfficeofScienceOperations.FormoreonAHAstatementsandguidelinesdevelopment,visithttp://professional.heart.org/statements.Selectthe“Guidelines&Statements”drop-downmenu,thenclick“PublicationDevelopment.”Permissions:Multiplecopies,modification,alteration,en-hancement,and/ordistributionofthisdocumentarenotpermit-tedwithouttheexpresspermissionoftheAmericanHeartAsso-ciation.Instructionsforobtainingpermissionarelocatedathttp://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp.Alinktothe“CopyrightPermissionsRequestForm”appearsontherightsideofthepage.Circulationisavailableathttp://circ.ahajournals.org.2017FocusedUpdate:PediatricBLSRecommendationsYearLastReviewedTopicRecommendationComments2017Componentsofhigh-qualityCPR:chestcompression‒onlyCPRChestcompressionswithrescuebreathsshouldbeprovidedforinfantsandchildrenincardiacarrest(ClassI;LevelofEvidenceB-NR).Updatedfor20172017Componentsofhigh-qualityCPR:chestcompression–onlyCPRIfbystandersareunwillingorunabletodeliverrescuebreaths,werecommendthatrescuersprovidechestcompressionsforinfantsandchildren(ClassI;LevelofEvidenceB-NR).Updatedfor2017BLSindicatesbasiclifesupport;andCPR,cardiopulmonaryresuscitation.DISCLOSURESWritingGroupDisclosuresWritingGroupMemberEmploymentResearchGrantOtherResearchSupportSpeakers’Bureau/HonorariaExpertWitnessOwnershipInterestConsultant/AdvisoryBoardOtherDianneL.AtkinsUniversityofIowaNoneNoneNoneNoneNoneNoneNoneStuartBergerMedicalCollegeofWisconsinNoneNoneNoneNoneNoneNoneNoneBlairL.BighamSt.Michael’sHospital,UniversityofTorontoNoneNoneNoneNoneNoneNoneNoneAllanR.deCaenUniversityofAlberta,StolleryChildren’sHospitalPediatricsNoneNoneNoneNoneNoneNoneNoneJonathanP.DuffUniversityofAlberta,StolleryChildren’sHospitalNoneNoneNoneNoneNoneNoneNone(Continued)byguestonNovember8,2017http://circ.ahajournals.org/DownloadedfromPediatricBLSandCPRQuality:FocusedUpdatetotheAHAGuidelinesforCPRandECCCirculation.2017;136:00–00.DOI:10.1161/CIR.0000000000000540TBDTBD,2017e5CLINICALSTATEMENTSANDGUIDELINESElizabethA.HuntJohnsHopkinsUniversityNIH(coinvestigatoronNIHgrant)*NoneNoneNoneNoneZollMedicalCorp*NoneBennyL.Joyner,JrUniversityofNorthCarolinaNoneNoneNoneNoneNoneNoneNonePeterA.MeaneyChildren’sHospitalofPhiladelphiaNoneNoneNone2017,Defense,ICUcarefordiagnosisandmanagementofgraftvshostdisease*NoneNoneNoneDanaE.NilesChildren’sHospitalofPhiladelphiaNoneNoneNoneNoneNoneNoneNoneRicardoA.SamsonChildren’sHeartCenter–NevadaNoneNoneNoneNoneNoneNoneNoneStephenM.SchexnayderUniversityofArkansas/ArkansasChildren’sHospitalNoneNoneNoneDefenseexpert*NoneCoursedevelopmentandscientificeditingconsultant†NoneThistablerepresentstherelationshipsofwritinggroupmembersthatmaybeperceivedasactualorreasonablyperceivedconflictsofinterestasreportedontheDisclosureQuestionnaire,whichallmembersofthewritinggrouparerequiredtocompleteandsubmit.Arelationshipisconsideredtobe“significant”if(a)thepersonreceives$10000ormoreduringany12-monthperiod,or5%ormoreoftheperson’sgrossincome;or(b)thepersonowns5%ormoreofthevotingstockorshareoftheentity,orowns$10000ormoreofthefairmarketvalueoftheentity.Arelationshipisconsideredtobe“modest”ifitislessthan“significant”undertheprecedingdefinition.*Modest.†Significant.ReviewerDisclosuresReviewerEmploymentResearchGrantOtherResearchSupportSpeakers’Bureau/HonorariaExpertWitnessOwnershipInterestConsultant/AdvisoryBoardOtherMarcAuerbachYaleUniversityNoneNoneNoneNoneNoneNoneNoneAartiBavareBaylorCollegeofMedicineNoneNoneNoneNoneNoneNoneNoneSilviaM.HartmannSeattleChildren’sHospitalpediRES-QCollaborative(receivedresearchfundingbyenrollingpatientsafteracardiacarrestthatcanbeusedtofundotherresearchprojects)*NoneNoneNoneNoneNoneNoneGeorgSchmölzerRoyalAlexandraHospital(Canada)NoneNoneNoneNoneNoneNoneNoneThistablerepresentstherelationshipsofreviewersthatmaybeperceivedasactualorreasonablyperceivedconflictsofinterestasreportedontheDisclosureQuestionnaire,whichallreviewersarerequiredtocompleteandsubmit.Arelationshipisconsideredtobe“significant”if(a)thepersonreceives$10000ormoreduringany12-monthperiod,or5%ormoreoftheperson’sgrossincome;or(b)thepersonowns5%ormoreofthevotingstockorshareoftheentity,orowns$10000ormoreofthefairmarketvalueoftheentity.Arelationshipisconsideredtobe“modest”ifitislessthan“significant”undertheprecedingdefinition.*Modest.REFERENCES1.OlasveengenTM,deCaenAR,ManciniME,MaconochieIK,AickinR,AtkinsDL,BergRA,BinghamR,BrooksSC,CastrénM,ChungSP,Con-sidineJ,CoutoTB,EscalanteR,GazmuriRJ,GuerguerianAM,HatanakaT,KosterRW,KudenchukPJ,LangE,LimSH,LøfgrenB,MeaneyPA,MontgomeryWH,MorleyPT,MorrisonLJ,NationKJ,NgKC,NadkarniVM,NishiyamaC,NuthallG,OngYKG,PerkinsGD,ReisAG,RistagnoG,SakamotoT,SayreMR,SchexnayderSM,SierraA,SingletaryEM,ShimizuN,SmythMA,StantonD,TijssenJA,TraversAH,VaillancourtC,VandeVoordeP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