Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B1W8, Canada.
Resuscitation. 2011 Aug;82(8):979-83. doi: 10.1016/j.resuscitation.2011.03.024. Epub 2011 Mar 31.
We examined the effect of the 2005 American Heart Association guidelines on survival in the Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry.
We surveyed 174 EMS agencies from 8 of 10 ROC sites to determine 2005 AHA guideline implementation, or crossover, date. Two sites with 2005 compatible treatment algorithms prior to guideline release, and agencies that did not adopt the new guidelines during the study period were excluded. Non-traumatic adult cardiac arrests that were not witnessed by EMS, and did not have do not resuscitate orders were included. A linear mixed effects model was applied for survival controlling for time and agency. The "crossover" date was added to the model to determine the effect of the 2005 guidelines.
Of 174 agencies, 85 contributed cases to both cohorts during the 18 month period between 2005/12/01 and 2007/05/31. Of 7779 cases, 5054 occurred during the 13 month (median) interval before crossover and 2725 occurred in the five month (median) interval after crossover. The overall survival rate was 6.1%; 5.8% in the old cohort vs. 6.5%, p=0.23. For VF/VT patients, survival was 14.6% vs. 18.0%, p=0.063. Our model estimated no increase in survival over time (monthly OR 1.014, 95% CI 0.988, 1.041, p=0.28).
This study found no significant change in survival rate over time in the early months after implementation. Further longitudinal study is needed to determine the full impact of the guidelines on survival and methods to translate knowledge quickly and effectively in EMS.
我们研究了 2005 年美国心脏协会指南对复苏结果联合会（ROC）心脏骤停研究中的生存率的影响。
我们调查了 8 个 ROC 地点的 174 个 EMS 机构，以确定 2005 年 AHA 指南的实施或交叉日期。排除了在指南发布之前具有 2005 年兼容治疗算法的两个地点和在研究期间未采用新指南的机构。不包括非创伤性成人心脏骤停，这些心脏骤停未被 EMS 人员目击，并且没有下达不复苏命令。应用线性混合效应模型来控制时间和机构因素对生存率的影响。将“交叉”日期添加到模型中，以确定 2005 年指南的影响。
在 2005 年 12 月 1 日至 2007 年 5 月 31 日的 18 个月期间，174 个机构中有 85 个机构为两个队列提供了病例。在 7779 例中，有 5054 例发生在交叉前 13 个月（中位数）期间，有 2725 例发生在交叉后 5 个月（中位数）期间。总体生存率为 6.1％；旧队列为 5.8％，新队列为 6.5％，p=0.23。对于 VF/VT 患者，生存率为 14.6％，p=0.063。我们的模型估计生存率随时间的增加而没有增加（每月 OR 1.014，95％CI 0.988，1.041，p=0.28）。
这项研究发现，在指南实施后的早期几个月中，生存率没有随时间明显变化。需要进一步的纵向研究来确定指南对生存率的全面影响，以及在 EMS 中快速有效地转化知识的方法。
