Swor Robert, Compton Scott
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Prehosp Emerg Care. 2004 Oct-Dec;8(4):420-3. doi: 10.1016/j.prehos.2004.06.012.
Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals.
To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training.
A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated.
There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged < or = 50 years and 8,796 bystanders aged > 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged < or = 50 years was 313,214 dollars, and that for a bystander aged > 50 years was 785,040 dollars. Using a strategy of training only those < or = 50 years, 583 elders per cardiac arrest would need to be trained, with a cost of 53,383 dollars per life saved.
Using these assumptions, current CPR training strategy is not a cost-effective intervention for home cardiac arrests. The high rate of elders witnessing CPR mandates focused CPR interventions for this population.
大多数心肺复苏（CPR）培训学员较为年轻，而大多数心脏骤停事件发生在私人住宅中，目击者多为年长者。
评估针对50岁以上公民的心肺复苏培训项目与当前非针对性公众心肺复苏培训相比的成本效益。
利用来自一个郊区邮政编码区域（人口36325）的心脏骤停和已知人口统计学数据建立模型，包括：关于心脏骤停地点（公共场合与私人住宅）的本地数据（1997 - 1999年）；心肺复苏后的生存增量（历史生存率7.8%，心肺复苏的调整优势比为2.0）；通过旁观者电话访谈获得的心脏骤停旁观者人口统计学信息；关于人口年龄和分布的邮政编码区域人口统计学信息；以及心肺复苏培训每位学员的成本为12.50美元。采用已公布的按年龄划分的心肺复苏培训项目率来估计通常接受培训的人数。做出了几个假设：1）每次心脏骤停有一名旁观者；2）旁观者若接受培训总会进行心肺复苏；3）心脏骤停在人群中均匀分布；4）对一部分人群进行心肺复苏培训将按比例增加心肺复苏的实施。计算了一年研究期内的心脏骤停发生率、按年龄划分的旁观者人数、为提高心脏骤停生存率所需的心肺复苏培训学员人数以及每挽救一条生命的培训成本。
每年有24.3例心脏骤停，其中21.9例（90%）发生在家中。在66.5%的家庭心脏骤停事件中，旁观者年龄超过50岁。采用当前的心肺复苏培训策略要多挽救一名幸存者，需要培训12306人（3510名年龄≤50岁的旁观者和8796名年龄＞50岁的旁观者），这使得多7.14名患者得到了心肺复苏。年龄≤50岁的旁观者每挽救一条生命的培训成本为313214美元，年龄＞50岁的旁观者为785040美元。采用仅培训年龄≤50岁人群的策略，每次心脏骤停需要培训583名年长者，每挽救一条生命的成本为53383美元。
基于这些假设，当前的心肺复苏培训策略对于家庭心脏骤停不是一种具有成本效益的干预措施。年长者目睹心肺复苏的比例很高，因此需要针对该人群开展有针对性的心肺复苏干预措施。
