EMS 目击心脏骤停后生存率提高。复苏结果联盟（ROC）Epistry-心脏骤停的观察结果。
Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac arrest.
机构信息
University of Pittsburgh, Department of Emergency Medicine, Suite 400A, Pittsburgh, PA 15261, USA.
出版信息
Resuscitation. 2010 Jul;81(7):826-30. doi: 10.1016/j.resuscitation.2010.02.005. Epub 2010 Apr 18.
BACKGROUND
Out of hospital cardiac arrest (OHCA) is common and lethal. It has been suggested that OHCA witnessed by EMS providers is a predictor of survival because advanced help is immediately available. We examined EMS witnessed OHCA from the Resuscitation Outcomes Consortium (ROC) to determine the effect of EMS witnessed vs. bystander witnessed and unwitnessed OHCA.
METHODS
Data were analyzed from a prospective, population-based cohort study in 10 U.S. and Canadian ROC sites. Individuals with non-traumatic OHCA treated 04/01/06-03/31/07 by EMS providers with defibrillation or chest compressions were included. Cases were grouped into EMS-witnessed, bystander witnessed, and unwitnessed and further stratified for bystander CPR. Multiple logistic regressions evaluated the odds ratio (OR) for survival to discharge relative to the EMS-witnessed group after adjusting for age, sex, public/private location of collapse, ROC site, and initial ECG rhythm. Of 9991 OHCA, 1022 (10.2%) of EMS-witnessed, 3369 (33.7%) bystander witnessed, and 5600 (56.1%) unwitnessed.
RESULTS
The most common initial rhythm in the EMS-witnessed group was PEA which was higher than in the bystander- and unwitnessed groups (p<0.001). The adjusted OR (95% CI) of survival compared to the EMS-witnessed group was 0.41, (0.36, 0.46) in bystander witnessed with bystander CPR, 0.37 (0.33, 0.43) in bystander witnessed without bystander CPR, 0.17 (0.14, 0.20) in unwitnessed with bystander CPR and 0.21 (0.18, 0.24) in unwitnessed cases without bystander CPR.
CONCLUSIONS
Immediate application of prehospital care for OHCA may improve survival. Efforts should be made to educate patients to access 9-1-1 for prodromal symptoms.
背景
院外心搏骤停（OHCA）很常见且致命。有研究表明，由急救医疗服务（EMS）提供者目击的 OHCA 是生存的预测因素，因为可以立即获得高级帮助。我们检查了复苏结果联合会（ROC）中的 EMS 目击 OHCA，以确定 EMS 目击与旁观者目击和无人目击 OHCA 的效果。
方法
对来自美国和加拿大 10 个 ROC 地点的前瞻性、基于人群的队列研究中的数据进行了分析。纳入了 2006 年 4 月 1 日至 2007 年 3 月 31 日由 EMS 提供者进行除颤或胸外按压治疗的非创伤性 OHCA 个体。病例分为 EMS 目击、旁观者目击和无人目击，并进一步按旁观者心肺复苏（CPR）分层。多变量逻辑回归评估了调整年龄、性别、崩溃的公共/私人地点、ROC 地点和初始心电图节律后，与 EMS 目击组相比，存活至出院的优势比（OR）。在 9991 例 OHCA 中，1022 例（10.2%）为 EMS 目击，3369 例（33.7%）为旁观者目击，5600 例（56.1%）为无人目击。
结果
EMS 目击组最常见的初始节律是 PEA，高于旁观者和无人目击组（p<0.001）。与 EMS 目击组相比，旁观者目击且有旁观者 CPR 的调整后 OR（95%CI）为 0.41（0.36，0.46），旁观者目击且无旁观者 CPR 的调整后 OR 为 0.37（0.33，0.43），有旁观者 CPR 的无人目击的调整后 OR 为 0.17（0.14，0.20），无旁观者 CPR 的无人目击的调整后 OR 为 0.21（0.18，0.24）。
结论
OHCA 的院前急救的立即应用可能会提高生存率。应努力教育患者在出现前驱症状时拨打 9-1-1。
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