腹部CPR与海姆立克急救法

腹部CPR与海姆立克急救法陈彦海姆立克急救法1974年，亨利·海姆立克发明了利用腹部冲击解除气道异物的急救方法。1975年10月，美国医学会以他的名字命名了该急救方法。《世界名人录》：海姆立克为“世界上拯救生命最多的人”！JAmMedAssoc.1975;234:398–401.Published2014byPrometheusBooks清醒昏迷自救原理异物导致气道梗阻冲击中上腹膈肌上抬肺内残留气体形成气流气体冲出气道排出异物腹部CPRLifestickresuscitator[Abstract]ThemethodutilizesstandardCPRtechniqueswiththeadditionofmanualabdominalcompressions(congruentto100mmHg)interposedbetweenchestcompressions,andistermedinterposedabdominalcompression-CPR(IAC-CPR).Ventricularfibrillationwasinducedelectricallyin10anesthetizeddogs.Ineachdog,trialsofIAC-CPRandstandardCPRwerealternatedeveryfiveminutesduringa30-minuteperiod.Arterialandcentralvenousbloodpressures,oxygenconsumption,andFickcardiacoutputweremonitored.Theadditionofinterposedabdominalcompressionsignificantly(P0.01)increasedeachofthesehemodynamicindicators.Oxygendeliveryincreasedfrom4.12+/-0.39mlO2/kg/minduringstandardCPRto6.37+/-0.35mlO2/kg/minduringIAC-CPR.Arterialsystolicbloodpressureincreasedfrom67+/-5mmHgto90+/-5mmHg,whilediastolicarterialbloodpressurerosefrom15+/-2mmHgto33+/-3mmHg.Cardiacoutputincreasedfrom19.9+/-2.6ml/min/kgto37.5+/-2.7ml/min/kg.AnnEmergMed.1983Mar;12(3):128-35.Improvedoxygendeliveryduringcardiopulmonaryresuscitationwithinterposedabdominalcompressions.Resuscitation.2003Oct;59(1):71-82.InterposedabdominalcompressionCPR:acomprehensiveevidencebasedreview.[Abstract]IAC-CPRincludesallstepsofstandardexternalCPRwiththeadditionofmanualmidabdominalcompressionsincounterpointtotherhythmofchestcompressions.IAC-CPRcanincreasebloodflowduringCPRabout2-foldcomparedwithstandardCPRwithoutIAC,asshownbysixofsixstudiesincomputermodelsand19of20studiesinvariousanimalmodels.TheadditionofIAChasclinicalbenefitinhumans,asindicatedin10of12smalltomediumsizedclinicalstudies.Thetechniqueincreasesthefrequencyofimmediatereturnofspontaneouscirculationforin-hospitalresuscitationsfromroughly25to50%.Possibleharmfromabdominalcompressionisminimalonthebasisof426humans,151dogsand14pigsthatreceivedIACinpublishedreports.ThecomplexityofperformingIACissimilartothatofopeningtheairwayandislessthanthatofotherbasiclifesupportmaneuvers.TheaggregateevidencesuggeststhatIAC-CPRisasafeandeffectivemeanstoincreaseorganperfusionandsurvival,whenperformedbyprofessionallytrainedrespondersinahospitalandwheninitiatedearlyintheresuscitationprotocol.CostandlogisticalconsiderationsdiscourageuseofIAC-CPRoutsideofhospitals.LevelCapsuledescriptionoflevel#ofpapers1Largerrandomizedclinicaltrials32Smallerrandomizedclinicaltrials13Prospective,non-randomizedcohortstudies24Historic,non-randomizedcohortstudies35Humancaseseries36Animalormechanicalmodelstudies257Rationalextrapolationsorquasi-experimentaldesigns18Commonsense,etc.0DatabasecompositionbylevelofevidencePerformancesitesforreviewedstudiesincludedUSA28studies,UK2,Israel2,Canada2,Japan1,Germany1,Netherlands1,Spain1,andItaly1(somestudieshadmultiplesites).按压位置相同：中上腹，剑突与肚脐之间按压频率不同：海姆立克急救法无特殊要求腹部CPR按压频率同普通的CPR海姆立克急救法与腹部CPR腹部按压=调整频率的海姆立克急救法！海姆立克急救法有助于缩短按压中断时间海姆立克急救法有助于开放气道海姆立克急救法有助于缩短除颤准备时间海姆立克急救法与腹部CPR2015AHACPR指南尽可能减少按压的中断，其判断标准是：根据胸外按压在整体心肺复苏中所占比例确定，对于无高级气道接受CPR患者，要求按压目标比例≥60%。要求：按压中断时间限制在10秒以内2015AmericanHeartAssociationGuidelinesUpdateforCardiopulmonaryResuscitationandEmergencyCardiovascularCare.Circulation.2015;132:S315-573.01OPTION缩短按压中断时间AcadEmergMed.2016Apr;23(4):448-54.AComparisonoftheEffectofInterposedAbdominalCompressionCardiopulmonaryResuscitationandStandardCardiopulmonaryResuscitationMethodsonEnd-tidalCO2andtheReturnofSpontaneousCirculationFollowingCardiacArrest:AClinicalTrial.METHODS:AftercardiacarrestwasconfirmedinapatientatMashhadGhaemHospital,80caseswererandomlyassignedtooneofthetwomethodsofresuscitation,eitherIAC-CPRorSTD-CPR,respectively.TheIAC-CPRgroupreceivedSTD-CPRplusIAC-CPRandtheSTD-CPRgroupreceivedSTD-CPRonly.InIAC-CPRgroup,abdominalcompressionwasperformedwithopenhands,fusedtogetherincenterofabdomenbetweenthexiphoidandtheumbilicusduringtherelaxationphaseofchestcompression.Depth,rhythm,andrateofabdominalcompressionsweresimilartochestcompressionsandforceontheabdomenwasmaintaineduntilthebeginningofnextchestcompression.RESULTS:TherewasasignificantdifferencebetweenthetwogroupsinETCO2(p0.003),buttherewasnosignificantdifferenceasfarastheROSC(p0.50).CONCLUSION:TheincreaseintheETCO2duringIAC-CPRisanindicatoroftheincreaseincardiacoutputfollowingtheuseofthismethodofCPR.窒息是心跳呼吸骤停的重要原因之一02OPTION腹部按压有利于气道异物排出，解除气道梗阻，保持气道通畅。开放气道METHODS:Twelveswinewereanesthetized,intubatedandallowedtobreathespontaneously.Physiologicdeadspace,restingtidalvolume,compression-inducedlungairflow,andbloodpressureswererecorded.VentricularfibrillationwaselectricallyinducedandsubjectsweretreatedwitheitherstandardCPRorOAC-CPRatvariousforceandratesettings.Minutealveolarventilation(MAV)andmeancoronaryperfusionpressure(CPP)werecompared.RESULTS:ForOAC-CPR,ventilationpercompressiontendedtoincreasewithincreasingforceanddecreasingrate.ChestonlycompressionsproducednoMAV,whileOAC-CPRat80cycles/minorless,matchedtheMAVforspontaneousrespiration.Forallrates,abdominalcompressionsmet,orexceeded,theC