Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Resuscitation. 2010 Mar;81(3):287-92. doi: 10.1016/j.resuscitation.2009.11.013. Epub 2009 Dec 22.
The purpose of this study was to investigate whether the takeover by Advanced Life Support [ALS] trained ambulance paramedics from rescuers using an automated external defibrillator [AED] delays shocks and if this delay is associated with decreased survival after out-of-hospital cardiac arrest [OHCA].
We analyzed continuous ECG recordings of LIFEPAK AEDs and associated manual defibrillator recordings of OHCA of presumed cardiac cause, prospectively collected from July 2005 to July 2009. The primary outcome measure was survival to discharge. Among 693 patients treated with AEDs, 110 had a shockable initial rhythm and a shockable rhythm during ALS takeover. We measured the time interval between the expected shock if the AED would remain attached to the patient and the first observed shock given by the manual defibrillator [shock timing].
Survival was 62% (13/21) if the shock was given early (<-20s), 52% (11/21; odds ratio [OR]=0.68, ns) if given on time (-20 to 20s), 29% (10/34; OR=0.26, 95% confidence interval [CI]=0.08-0.81; P=0.02) if the shock was 20-150s delayed and 21% (7/34; OR=0.16, 95% CI=0.05-0.54; P=0.003) if the shock was delayed >150s. The OR for trend was 0.41, 95% CI=0.25-0.71; P=0.001. The association between shock timing and survival was significant for patients with more than 150s shock delay (OR=0.19; 95% CI=0.04-0.71; P=0.02) or for trend in shock timing (0.42, 95% CI=0.20-0.84; P=0.02) after multivariable adjustment for prognostic factors age and slope of ventricular fibrillation.
ALS takeover delays the next shock delivery in almost two-third of cases. This delay is associated with decreased survival.
本研究旨在探讨由高级生命支持（ALS）培训的救护车护理人员从使用自动体外除颤器（AED）的救援人员手中接管时，是否会延迟电击，以及这种延迟是否与院外心脏骤停（OHCA）后生存率降低有关。
我们分析了 2005 年 7 月至 2009 年 7 月期间连续采集的 LIFEPAK AED 心电图记录和 OHCA 相关手动除颤器记录，这些 OHCA 被认为是心脏原因所致。主要结局测量指标为出院生存率。在 693 例接受 AED 治疗的患者中，有 110 例初始节律为可除颤节律，ALS 接管时节律为可除颤节律。我们测量了如果 AED 仍连接到患者身上，预期电击与手动除颤器首次观察到的电击之间的时间间隔[电击时间]。
如果电击时间较早（< -20s），则生存率为 62%（13/21）；如果电击时间正常（-20 至 20s），则生存率为 52%（11/21；比值比[OR]=0.68，无统计学意义）；如果电击时间延迟 20-150s，则生存率为 29%（10/34；OR=0.26，95%置信区间[CI]=0.08-0.81；P=0.02）；如果电击时间延迟>150s，则生存率为 21%（7/34；OR=0.16，95% CI=0.05-0.54；P=0.003）。趋势的 OR 为 0.41，95% CI=0.25-0.71；P=0.001。在对年龄和心室颤动斜率等预后因素进行多变量调整后，对于电击时间延迟超过 150s 的患者（OR=0.19；95% CI=0.04-0.71；P=0.02）或电击时间趋势（0.42，95% CI=0.20-0.84；P=0.02），电击时间与生存率之间的关联具有统计学意义。
ALS 接管几乎有三分之二的情况下会延迟下一次电击输送。这种延迟与生存率降低有关。
