Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
Prehosp Emerg Care. 2011 Jan-Mar;15(1):55-60. doi: 10.3109/10903127.2010.514089. Epub 2010 Sep 13.
Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes.
To compare the rates of return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) between paramedic-witnessed out-of-hospital cardiac arrest vs. citizen-witnessed out-of-hospital cardiac arrest.
In this retrospective cohort study, the records of all out-of-hospital nontraumatic cardiac arrest patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The age, gender, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether it was a witnessed arrest and, if witnessed, whether it was a paramedic-witnessed arrest, site of the arrest, and the rate of SHD were noted. A univariate odds ratio was computed to describe the association between paramedic-witnessed out-of-hospital cardiac arrest vs.citizen-witnessed out-of-hospital cardiac arrest and SHD. A multivariable logistic regression analysis was also performed, controlling for age, gender, arrest rhythm, bystander CPR, and site of arrest.
Of the total cohort of 1,294 out-of-hospital cardiac arrests, 750 (52.6%) were either paramedic-witnessed (154/750 = 20.5%) or citizen-witnessed (596/750 = 79.5%). Among the witnessed cardiac arrests, overall the SHD was 53 of 750 (7.1%). On univariate analysis, the ROSC, SHA, or SHD rates were not statistically significantly different between paramedic- and citizen-witnessed arrests. Even after multivariable adjustment, the ROSC, SHA, and SHD rates were not significantly different between paramedic- and citizen-witnessed arrests.
Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests.
投入了大量的财力和人力资源来培训和维持急救人员的高级生命支持（ALS）技能，这些急救人员在接到院外心脏骤停的呼叫后被部署到现场。可以预期，在受过培训的医护人员（如急救人员）在场的情况下经历心脏骤停的患者，其结果会更好。
比较急救人员目击的院外心脏骤停与市民目击的院外心脏骤停之间自主循环恢复（ROSC）、入院存活率（SHA）和出院存活率（SHD）的比率。
在这项回顾性队列研究中，对 1994 年 11 月 1 日至 2008 年 6 月 30 日期间到一家市立教学医院就诊的所有非创伤性院外心脏骤停患者的记录进行了审查。记录了患者的年龄、性别、种族、急救人员到达时的节律、旁观者心肺复苏（CPR）的存在、是否为目击性骤停以及如果是目击性骤停，是否为急救人员目击性骤停、骤停地点以及 SHD 率。计算了单变量比值比，以描述急救人员目击的院外心脏骤停与市民目击的院外心脏骤停与 SHD 之间的关联。还进行了多变量逻辑回归分析，控制了年龄、性别、节律、旁观者 CPR 和骤停地点。
在总共 1294 例院外心脏骤停患者中，750 例（52.6%）为急救人员目击（154/750=20.5%）或市民目击（596/750=79.5%）。在目击性心脏骤停中，总共有 750 例中的 53 例（7.1%）存活出院。在单变量分析中，急救人员目击和市民目击的心脏骤停的 ROSC、SHA 或 SHD 率没有统计学差异。即使在多变量调整后，急救人员目击和市民目击的心脏骤停的 ROSC、SHA 和 SHD 率也没有显著差异。
在我们的院外心脏骤停患者研究人群中，与市民目击的心脏骤停相比，急救人员目击的心脏骤停似乎并未提高存活率。
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