Swor Robert, Khan Iftikhar, Domeier Robert, Honeycutt Linda, Chu Kevin, Compton Scott
Department of Emergency Medicine, Royal Oak William Beaumont Hospital, Royal Oak, MI, USA.
Acad Emerg Med. 2006 Jun;13(6):596-601. doi: 10.1197/j.aem.2005.12.021. Epub 2006 Apr 13.
To determine factors associated with cardiopulmonary resuscitation (CPR) provision by CPR-trained bystanders and to determine factors associated with CPR performance by trained bystanders.
The authors performed a prospective, observational study (January 1997 to May 2003) of individuals who called 911 (bystanders) at the time of an out-of-hospital cardiac arrest. A structured telephone interview of adult cardiac-arrest bystanders was performed beginning two weeks after the incident. Elements gathered during interviews included bystander and patient demographics, identifying whether the bystander was CPR trained, when and by whom the CPR was performed, and describing the circumstances of the event. If CPR was not performed, we asked the bystanders why CPR was not performed. Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) for factors associated with CPR performance.
Of 868 cardiac arrests, 684 (78.1%) bystander interviews were completed. Of all bystanders interviewed, 69.6% were family members of the victims, 36.8% of the bystanders had more than a high-school education, and 54.1% had been taught CPR at some time. In 21.2% of patients, the bystander immediately started CPR, and in 33.6% of cases, someone started CPR before the arrival of emergency medical services (EMS). Important overall predictors of CPR performance were the following: witnessed arrest (OR = 2.3; 95% CI = 1.4 to 3.8); bystander was CPR trained (OR = 6.6; 95% CI = 3.5 to 12.5); bystander had more than a high-school education (OR = 2.0; 95% CI = 1.2 to 3.1), or arrest occurred in a public location (OR = 3.1; 95% CI = 1.7 to 5.8). These variables were significant predictors of CPR performance among CPR-trained bystanders, as was CPR training within five years (OR = 4.5; 95% CI = 2.8 to 7.3). Common reasons that the CPR-trained bystanders cited for not performing CPR were the following: 37.5% stated that they panicked, 9.1% perceived that they would not be able to do CPR correctly, and 1.1% thought that they would hurt the patient. Surprisingly, only 1.1% objected to performing mouth-to-mouth resuscitation.
A minority of CPR-trained bystanders performed CPR. CPR provision was more common in CPR-trained bystanders with more than a high-school education and when CPR training had been within five years. Previously espoused reasons for not doing CPR (mouth-to-mouth, infectious-disease risk) were not the reasons that bystanders cited for not doing CPR. Further work is needed to maximize CPR provision after CPR training.
确定接受过心肺复苏（CPR）培训的旁观者实施CPR的相关因素，并确定受过培训的旁观者进行CPR操作的相关因素。
作者对1997年1月至2003年5月期间在院外心脏骤停时拨打911的人员（旁观者）进行了一项前瞻性观察研究。在事件发生两周后，对成年心脏骤停旁观者进行了结构化电话访谈。访谈中收集的内容包括旁观者和患者的人口统计学信息，确定旁观者是否接受过CPR培训、CPR的实施时间和实施者，并描述事件情况。如果未实施CPR，我们询问旁观者未实施的原因。采用逻辑回归计算与CPR操作相关因素的比值比和95%置信区间（95%CI）。
在868例心脏骤停事件中，完成了684例（78.1%）旁观者访谈。在所有接受访谈的旁观者中，69.6%是受害者的家庭成员，36.8%的旁观者受过高中以上教育，54.1%曾在某个时候接受过CPR培训。在21.2%的患者中，旁观者立即开始进行CPR，在33.6%的病例中，有人在紧急医疗服务（EMS）到达之前开始进行CPR。CPR操作的重要总体预测因素如下：目睹心脏骤停（比值比=2.3；95%CI=1.4至3.8）；旁观者接受过CPR培训（比值比=6.6；95%CI=3.5至12.5）；旁观者受过高中以上教育（比值比=2.0；95%CI=1.2至3.1），或心脏骤停发生在公共场所（比值比=3.1；95%CI=1.7至5.8）。这些变量是接受过CPR培训的旁观者中CPR操作的重要预测因素，五年内接受的CPR培训也是如此（比值比=4.5；95%CI=2.8至7.3）。接受过CPR培训的旁观者提到的未实施CPR的常见原因如下：37.5%表示他们惊慌失措，9.1%认为自己无法正确进行CPR，1.1%认为自己会伤害患者。令人惊讶的是，只有1.1%反对进行口对口复苏。
少数接受过CPR培训的旁观者实施了CPR。在受过高中以上教育且CPR培训在五年内的接受过CPR培训的旁观者中，实施CPR更为常见。以前提出的不进行CPR的原因（口对口、传染病风险）并不是旁观者提到的不进行CPR的原因。需要进一步开展工作，以在CPR培训后最大限度地提高CPR的实施率。
