旁观者行常规心肺复苏和单纯胸外按压心肺复苏对院外心搏骤停儿童的效果：一项前瞻性、全国性、基于人群的队列研究。

Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study.

机构信息

Kyoto University Health Service, Kyoto, Japan.

出版信息

Lancet. 2010 Apr 17;375(9723):1347-54. doi: 10.1016/S0140-6736(10)60064-5. Epub 2010 Mar 2.

DOI:10.1016/S0140-6736(10)60064-5

PMID:20202679

Abstract

BACKGROUND

The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. We assessed the effect of CPR (conventional with rescue breathing or chest compression only) by bystanders on outcomes after out-of-hospital cardiac arrests in children.

METHODS

In a nationwide, prospective, population-based, observational study, we enrolled 5170 children aged 17 years and younger who had an out-of-hospital cardiac arrest from Jan 1, 2005, to Dec 31, 2007. Data collected included age, cause, and presence and type of CPR by bystander. The primary endpoint was favourable neurological outcome 1 month after an out-of-hospital cardiac arrest, defined as Glasgow-Pittsburgh cerebral performance category 1 or 2.

FINDINGS

3675 (71%) children had arrests of non-cardiac causes and 1495 (29%) cardiac causes. 1551 (30%) received conventional CPR and 888 (17%) compression-only CPR. Data for type of CPR by bystander were not available for 12 children. Children who were given CPR by a bystander had a significantly higher rate of favourable neurological outcome than did those not given CPR (4.5% [110/2439] vs 1.9% [53/2719]; adjusted odds ratio [OR] 2.59, 95% CI 1.81-3.71). In children aged 1-17 years who had arrests of non-cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (5.1% [51/1004] vs 1.5% [20/1293]; OR 4.17, 2.37-7.32). However, conventional CPR produced more favourable neurological outcome than did compression-only CPR (7.2% [45/624] vs 1.6% [six of 380]; OR 5.54, 2.52-16.99). In children aged 1-17 years who had arrests of cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (9.5% [42/440] vs 4.1% [14/339]; OR 2.21, 1.08-4.54), and did not differ between conventional and compression-only CPR (9.9% [28/282] vs 8.9% [14/158]; OR 1.20, 0.55-2.66). In infants (aged <1 year), outcomes were uniformly poor (1.7% [36/2082] with favourable neurological outcome).

INTERPRETATION

For children who have out-of-hospital cardiac arrests from non-cardiac causes, conventional CPR (with rescue breathing) by bystander is the preferable approach to resuscitation. For arrests of cardiac causes, either conventional or compression-only CPR is similarly effective.

FUNDING

Fire and Disaster Management Agency and the Ministry of Education, Culture, Sports, Science and Technology (Japan).

摘要

背景

美国心脏协会建议，对发生心搏骤停的成人，由旁观者行单纯胸外按压心肺复苏，但不建议用于儿童。我们评估了旁观者行心肺复苏（常规心肺复苏或单纯胸外按压）对儿童院外心搏骤停后结局的影响。

方法

在一项全国性、前瞻性、基于人群的观察性研究中，我们纳入了 2005 年 1 月 1 日至 2007 年 12 月 31 日期间发生院外心搏骤停的 17 岁及以下儿童 5170 例。收集的数据包括年龄、病因以及旁观者是否存在并实施心肺复苏。主要终点为院外心搏骤停后 1 个月时的良好神经功能结局，定义为格拉斯哥-匹兹堡脑功能预后评分 1 或 2 级。

结果

3675 例（71%）儿童的心脏骤停为非心源性病因，1495 例（29%）为心源性病因。1551 例（30%）接受了常规心肺复苏，888 例（17%）接受了单纯胸外按压心肺复苏。有 12 例儿童的旁观者心肺复苏类型数据无法获得。与未接受心肺复苏的儿童相比，接受过旁观者心肺复苏的儿童有更高的良好神经功能结局发生率（4.5%[110/2439] vs 1.9%[53/2719]；调整后比值比[OR]2.59，95%CI 1.81-3.71）。在 1-17 岁非心源性病因所致心脏骤停的儿童中，旁观者心肺复苏后良好神经功能结局更为常见（5.1%[51/1004] vs 1.5%[20/1293]；OR 4.17，2.37-7.32）。然而，常规心肺复苏后的良好神经功能结局发生率高于单纯胸外按压心肺复苏（7.2%[45/624] vs 1.6%[6/380]；OR 5.54，2.52-16.99）。在 1-17 岁心源性病因所致心脏骤停的儿童中，旁观者心肺复苏后良好神经功能结局更为常见（9.5%[42/440] vs 4.1%[14/339]；OR 2.21，1.08-4.54），且与常规心肺复苏和单纯胸外按压心肺复苏之间均无差异（9.9%[28/282] vs 8.9%[14/158]；OR 1.20，0.55-2.66）。在婴儿（年龄＜1 岁）中，结局均较差（1.7%[36/2082]具有良好神经功能结局）。