Swor Robert A, Jackson R E, Compton S, Domeier R, Zalenski R, Honeycutt L, Kuhn G J, Frederiksen S, Pascual R G
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Resuscitation. 2003 Aug;58(2):171-6. doi: 10.1016/s0300-9572(03)00118-7.
A tremendous amount of public resources are focused on improving cardiac arrest (OHCA) survival in public places, yet most OHCAs occur in private residences.
A prospective, observational study of patients transported to seven urban and suburban hospitals and the individuals who called 911 at the time of a cardiac arrest (bystander) was performed. Bystanders (N=543) were interviewed via telephone beginning 2 weeks after the incident to obtain data regarding patient and bystander demographics, including cardiopulmonary resuscitation (CPR) training. Of all arrests 80.2% were in homes. Patients who arrested in public places were significantly younger (63.2 vs. 67.2, P<0.02), more often had an initial rhythm of VF (63.0 vs. 37.7%, P<0.001), were seen or heard to have collapsed by a bystander (74.8 vs. 48.1%, P<0.001), received bystander CPR (60.2 vs. 28.6%, P<0.001), and survived to DC (17.5 vs. 5.5%, P<0.001). Patients who arrested at home were older and had an older bystander (55.4 vs. 41.3, P<0.001). The bystander was less likely to be CPR trained (65.0 vs. 47.4%, P<0.001), less likely to be trained within the last 5 years (49.2 vs. 17.9, P<0.001), and less likely to perform CPR if trained (64.2 vs. 30.0%, P<0.001). Collapse to shock intervals for public versus home VF patients were not different.
Many important characteristics of cardiac arrest patients and the bystander differ in public versus private locations. Fundamentally different strategies are needed to improve survival from these events.
大量公共资源集中用于提高公共场所心脏骤停（院外心脏骤停，OHCA）的生存率，然而大多数院外心脏骤停发生在私人住宅中。
对转运至7家城市和郊区医院的患者以及心脏骤停发生时拨打911的人员（旁观者）进行了一项前瞻性观察研究。事件发生2周后开始通过电话对旁观者（N = 543）进行访谈，以获取有关患者和旁观者人口统计学的数据，包括心肺复苏（CPR）培训情况。在所有心脏骤停事件中，80.2%发生在家中。在公共场所发生心脏骤停的患者明显更年轻（63.2岁对67.2岁，P<0.02），初始心律为室颤（VF）的情况更常见（63.0%对37.7%，P<0.001），被旁观者看到或听到倒下的情况更常见（74.8%对48.1%，P<0.001），接受旁观者心肺复苏的情况更常见（60.2%对28.6%，P<0.001），并且存活至出院的情况更常见（17.5%对5.5%，P<0.001）。在家中发生心脏骤停的患者年龄更大，旁观者年龄也更大（55.4岁对41.3岁，P<0.001）。旁观者接受心肺复苏培训的可能性较小（65.0%对47.4%，P<0.001），在过去5年内接受培训的可能性较小（49.2对17.9，P<0.001），并且如果接受培训进行心肺复苏的可能性也较小（64.2%对30.0%，P<0.001）。公共场所与家中室颤患者从心脏骤停到休克的间隔时间没有差异。
心脏骤停患者和旁观者的许多重要特征在公共场所和私人场所存在差异。需要根本不同的策略来提高这些事件的生存率。
