Emergency Medical Services Division of Public Health for Seattle and King County, Seattle, Washington, USA.
N Engl J Med. 2010 Jul 29;363(5):423-33. doi: 10.1056/NEJMoa0908993.
The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.
We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.
Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P=0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P=0.13). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P=0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P=0.09).
Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
在非专业人员进行的心肺复苏术（CPR）中，抢救性呼吸的作用尚不确定。我们假设，与指导旁观者进行胸外按压加抢救性呼吸相比，指示调度员指导旁观者仅进行胸外按压，会提高生存率。
我们进行了一项多中心、随机试验，调度员指导旁观者进行 CPR。患者为年龄在 18 岁及以上、院外发生心搏骤停、调度员开始向旁观者进行 CPR 指导的人员。患者被随机分配接受单纯胸外按压或胸外按压加抢救性呼吸。主要结局为出院时的存活。次要结局包括出院时的良好神经功能结局。
在符合纳入标准的 1941 名患者中，981 名被随机分配接受单纯胸外按压，960 名接受胸外按压加抢救性呼吸。我们未观察到两组在出院时存活的患者比例（单纯胸外按压组为 12.5%，胸外按压加抢救性呼吸组为 11.0%，P=0.31）或在评估这一次要结局的两个地点存活且具有良好神经功能结局的患者比例（分别为 14.4%和 11.5%，P=0.13）方面有显著差异。预先设定的亚组分析显示，与胸外按压加抢救性呼吸相比，单纯胸外按压在因心脏原因导致骤停的患者（15.5%比 12.3%，P=0.09）和有可除颤节律的患者（31.9%比 25.7%，P=0.09）中，出院时存活的患者比例有升高的趋势。
仅进行胸外按压的调度员指导并未整体提高生存率，但在关键临床亚组中，结果有改善的趋势。这些结果支持一种由非专业人员实施的 CPR 策略，该策略强调胸外按压并尽量减少抢救性呼吸的作用。（部分由 Laerdal 急性医学基金会和 Medic One 基金会资助；ClinicalTrials.gov 编号：NCT00219687）
