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首页> 外文期刊>Resuscitation. >Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review.
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Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review.

机译：院前经皮心脏起搏治疗有症状的心动过缓或心动过缓的心脏骤停：系统评价。

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BACKGROUND: Advanced cardiac life support (ACLS) guidelines suggest transcutaneous cardiac pacing (TCP) for the treatment of symptomatic bradycardia (SB) and bradyasystolic cardiac arrest (BACA). Many EMS systems are extrapolating these guidelines and employing TCP in the prehospital setting. Our objective was to conduct a systematic review to determine the efficacy of prehospital TCP in the management of these two conditions. METHODS: MEDLINE (1966-2004), EMBase and Science Citation Index (1980-2004) were searched using: prehospital/emergency medical services; external/transcutaneous; pacing. Two reviewer teams blinded to the source and author conducted a hierarchical selection (title, abstract, article) and quality assessment using a validated scale. Kappa agreement at each level of review was measured. Data abstraction was done by consensus. RESULTS: Thirty-four articles were identified and seven selected (Kappa agreement; title: 0.85, abstract: 0.78, full article: 0.82). Article quality was poor inall trials. There were three case series (BACA, n=215), three unblinded randomised controlled trials (one BACA, two BACA+SB), and one subgroup (SB) analysis. In the case series of paced BACA patients, 0/215 survived to hospital discharge. In the BACA trials 16/509 (paced) versus14/497 (control) survived to discharge. In a subgroup of one SB trial 5/6 (paced) versus 1/7 (control) survived to discharge (p=0.01). When a SB trial subgroup was combined with a case series 4/27 (paced) versus 0/24 (control) survived to discharge (p=0.07). CONCLUSIONS: In the prehospital setting, there is no evidence to support the use of TCP in bradyasystolic cardiac arrest. There is inadequate evidence to determine the efficacy of prehospital TCP in the treatment of symptomatic bradycardia.
机译：背景：先进的心脏生命支持（ACLS）指南建议采用经皮心脏起搏（TCP）来治疗有症状的心动过缓（SB）和臂丛收缩性心脏骤停（BACA）。许多EMS系统正在推断这些准则，并在院前环境中采用TCP。我们的目标是进行系统的评估，以确定院前TCP在这两种情况下的疗效。方法：使用以下方法搜索MEDLINE（1966-2004），EMBase和科学引文索引（1980-2004）：院前/急诊医疗服务;外部/经皮;起搏。两个审阅者团队对来源不了解，作者使用经过验证的量表进行了层次选择（标题，摘要，文章）和质量评估。评估了每个审查级别的Kappa协议。数据抽象是通过共识完成的。结果：确定了34篇文章，选择了7篇文章（Kappa协议;标题：0.85，摘要：0.78，全文：0.82）。在所有试验中，物品质量均较差。有三个病例系列（BACA，n = 215），三个非盲随机对照试验（一个BACA，两个BACA + SB）和一个亚组（SB）分析。在一系列有节奏的BACA患者中，0/215存活到出院。在BACA试验中，16/509（起搏）对14/497（对照）存活下来。在一项SB试验的亚组中，5/6（起搏）对1/7（对照）存活至出院（p = 0.01）。当SB试验亚组与4/27（步调）对0/24（对照）的病例组合并时，存活下来（p = 0.07）。结论：在院前环境中，尚无证据支持TCP可用于舒张性收缩期心脏骤停。没有足够的证据来确定院前TCP在治疗症状性心动过缓中的疗效。

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