Nichol G, Steen P, Herlitz J, Morrison L J, Jacobs I, Ornato J P, O'Connor R, Nadkarni V
University of Washington, Seattle, WA 98104, USA.
Resuscitation. 2005 Jun;65(3):265-77. doi: 10.1016/j.resuscitation.2004.12.019.
There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1+/-5.1 min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.
由于数据收集不统一，缺乏关于复苏干预效果以及院外心脏骤停和心肺复苏后在结构、过程和结果方面的国际差异的高质量信息。基于互联网的国际登记系统可以使此类评估成为可能，并能够开展大规模的复苏治疗随机对照试验。进行了一项前瞻性国际队列研究，纳入了571名婴儿、儿童和成人，这些人（a）经历了需要胸外按压或体外除颤的心脏骤停，（b）在研究社区的医院外，并且（c）急救人员对其进行了复苏尝试。心脏骤停被定义为激活急救医疗服务系统且完成了骤停记录的个体出现无反应、无呼吸或无运动。所有数据通过安全且保密的基于网络的方法进行整理，使用具有适当变量范围检查、逻辑检查和跳过规则的自动表单处理软件。每个变量缺失回答的中位数为0（四分位间距为0, 0）。27%的患者首次记录的心律为室颤或室速，60%的患者心脏骤停有目击者，34%的患者接受了旁观者心肺复苏。从呼叫到到达现场的平均时间为7.1±5.1分钟。6%的患者存活至出院。各中心的复苏过程差异很大，各中心的存活率和神经学结局也存在显著且独立差异。这项研究表明，通过互联网前瞻性收集多个国际地点与心脏骤停相关的结构、过程和结果的数据是可行的。因此，在国际环境中开展有足够效力的复苏治疗随机试验是可行的。
