Soo L H, Gray D, Young T, Huff N, Skene A, Hampton J R
Department of Cardiovascular Medicine, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK.
Heart. 1999 Jan;81(1):47-52. doi: 10.1136/hrt.81.1.47.
To determine whether survival from out-of-hospital cardiac arrest is influenced by the on-scene availability of different grades of ambulance personnel and other health professionals.
Population based, retrospective, observational study.
County of Nottinghamshire with a population of one million.
All 2094 patients who had resuscitation attempted by Nottinghamshire Ambulance Service crew from 1991 to 1994; study of 1547 patients whose arrest were of cardiac aetiology.
Survival to hospital admission and survival to hospital discharge.
Overall survival from out-of-hospital cardiac arrest remains poor: 221 patients (14.3%) survived to reach hospital alive and only 94 (6.1%) survived to be discharged from hospital. Multivariate logistic regression analysis showed that the chances of those resuscitated by technician crew reaching hospital alive were poor but were greater when paramedic crew were either called to assist technicians or dealt with the arrest themselves (odds ratio 6.9 (95% confidence interval 3.92 to 26.61)). Compared to technician crew, survival to hospital discharge was only significantly improved with paramedic crew (3.55 (1.62 to 7.79)) and further improved when paramedics were assisted by either a health professional (9.91 (3.12 to 26.61)) or a medical practitioner (20.88 (6.72 to 64.94)).
Survival from out-of-hospital cardiac arrest remains poor despite attendance at the scene of the arrest by ambulance crew and other health professionals. Patients resuscitated by a paramedic from out-of-hospital cardiac arrest caused by cardiac disease were more likely to survive to hospital discharge than when resuscitation was provided by an ambulance technician. Resuscitation by a paramedic assisted by a medical practitioner offers a patient the best chances of surviving the event.
确定院外心脏骤停患者的存活情况是否受到不同级别救护人员及其他卫生专业人员现场可及性的影响。
基于人群的回顾性观察研究。
诺丁汉郡，人口一百万。
1991年至1994年期间由诺丁汉郡救护服务人员尝试进行复苏的所有2094例患者；对其中1547例心脏病因导致骤停的患者进行研究。
存活至入院及存活至出院。
院外心脏骤停患者的总体存活率仍然很低：221例患者（14.3%）存活至入院，仅有94例（6.1%）存活至出院。多因素逻辑回归分析显示，由技术人员团队进行复苏的患者存活至入院的几率较低，但当护理人员被呼叫协助技术人员或自行处理骤停情况时，存活几率会更高（比值比6.9（95%置信区间3.92至26.61））。与技术人员团队相比，只有护理人员团队进行复苏时，患者存活至出院的情况才会显著改善（3.55（1.62至7.79）），当护理人员得到卫生专业人员（9.91（3.12至26.61））或医生（20.88（6.72至64.94））协助时，存活率会进一步提高。
尽管救护人员及其他卫生专业人员在心脏骤停现场进行了救治，但院外心脏骤停患者的存活率仍然很低。因心脏病导致院外心脏骤停时，由护理人员进行复苏的患者比由救护技术人员进行复苏的患者更有可能存活至出院。由医生协助护理人员进行复苏为患者提供了最佳的存活机会。
