最大化公众可及除颤效果的障碍：院外心脏骤停调度机制评估

The obstacles to maximising the impact of public access defibrillation: an assessment of the dispatch mechanism for out-of-hospital cardiac arrest.

作者信息

Cairns K J, Hamilton A J, Marshall A H, Moore M J, Adgey A A J, Kee F

机构信息

Centre for Statistical Science and Operational Research (CenSSOR), Sir David Bates Building, Queen's University Belfast, UK.

出版信息

Heart. 2008 Mar;94(3):349-53. doi: 10.1136/hrt.2006.109785. Epub 2007 May 31.

DOI:10.1136/hrt.2006.109785

PMID:17540690

Abstract

OBJECTIVES

To determine the diagnostic accuracy of advanced medical priority dispatch system (AMPDS) software used to dispatch public access defibrillation first responders to out-of-hospital cardiac arrests (OHCA).

DESIGN

All true OHCA events in North and West Belfast in 2004 were prospectively collated. This was achieved by a comprehensive search of all manually completed Patient Report Forms compiled by paramedics, together with autopsy reports, death certificates and medical records. The dispatch coding of all emergency calls by AMPDS software was also obtained for the same time period and region, and a comparison was made between these two datasets.

SETTING

A single urban ambulance control centre in Northern Ireland.

POPULATION

All 238 individuals with a presumed or actual OHCA in the North and West Belfast Health and Social Services Trust population of 138 591 (2001 Census), as defined by the Utstein Criteria.

MAIN OUTCOME MEASURES

The accurate dispatch of an emergency ambulance to a true OHCA.

RESULTS

The sensitivity of the dispatch mechanism for detecting OHCA was 68.9% (115/167, 95% confidence interval (CI) 61.3% to 75.8%). However, the sensitivity for arrests with ventricular fibrillation (VF) was 44.4% (12/27) with sensitivity for witnessed VF of 47.1% (8/17). The positive predictive value was 63.5% (115/181, 95% CI 56.1% to 70.6%).

CONCLUSIONS

The sensitivity of this dispatch process for cardiac arrest is moderate and will constrain the effectiveness of Public Access Defibrillation (PAD) schemes which utilise it.

TRIAL REGISTRATION

controlled-trials.com ISRCTN07286796.

摘要

目的

确定用于向院外心脏骤停（OHCA）事件派遣公众可获取除颤急救人员的高级医疗优先调度系统（AMPDS）软件的诊断准确性。

设计

对2004年北贝尔法斯特和西贝尔法斯特的所有真实OHCA事件进行前瞻性整理。这是通过全面搜索护理人员手动填写的所有患者报告表，以及尸检报告、死亡证明和医疗记录来实现的。同时还获取了同一时期和地区AMPDS软件对所有紧急呼叫的调度编码，并对这两个数据集进行了比较。

设置

北爱尔兰的一个城市救护车控制中心。

研究对象

根据乌斯坦标准定义，北贝尔法斯特和西贝尔法斯特健康与社会服务信托基金辖区内138591名居民（2001年人口普查数据）中所有238名疑似或实际发生OHCA的个体。

主要观察指标

向真正的OHCA准确派遣急救救护车。

结果

该调度机制检测OHCA的灵敏度为68.9%（115/167，95%置信区间（CI）61.3%至75.8%）。然而，对心室颤动（VF）性心脏骤停的灵敏度为44.4%（12/27），对目击VF的灵敏度为47.1%（8/17）。阳性预测值为63.5%（115/181，95%CI 56.1%至70.6%）。