Division of Emergency Medical Services, Public Health - Seattle & King County and University of Washington, Seattle, Washington, USA.
Curr Opin Crit Care. 2011 Jun;17(3):219-24. doi: 10.1097/MCC.0b013e32834697d8.
Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR.
Given the host of barriers, a successful strategy to improve bystander CPR must enable more timely and comprehensive arrest identification, encourage and empower bystanders to act, and help assure effective CPR. Arrest identification can be simplified so that bystanders should start CPR when a person is unconscious and not breathing normally. Evidence from observational studies and interventional trials supports the effectiveness of chest compression-only CPR for bystanders. As a consequence, the emphasis of bystander CPR training has been modified to feature and assure chest compressions. Bystanders should initiate CPR with compressions and consider the addition of rescue breathing based on their CPR training and skills as well as special circumstances of the victim. Bystander CPR training has evolved to incorporate this emphasis. Although general community-level CPR training remains a cornerstone strategy, training directed to those most likely to witness an arrest also has a useful role. In particular, 'just-in-time' dispatcher-assisted CPR instruction can increase bystander CPR and improve the likelihood of survival.
Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.
总结性评估表明，旁观者心肺复苏术（CPR）可将院外心脏骤停患者的生存机会提高两倍至三倍。然而，只有少数的心脏骤停患者能得到旁观者的 CPR。本综述将讨论实现早期有效旁观者 CPR 所面临的挑战和方法。
鉴于存在诸多障碍，提高旁观者 CPR 的成功率必须使更多的旁观者能够及时全面地识别出心脏骤停，并鼓励和授权他们采取行动，同时确保 CPR 的有效性。可以简化心脏骤停的识别，以便旁观者在患者无意识且无法正常呼吸时开始进行 CPR。来自观察性研究和干预性试验的证据支持旁观者进行单纯胸外按压式 CPR 的有效性。因此，旁观者 CPR 培训的重点已经修改，重点是保证胸外按压的实施。旁观者应该在开始 CPR 时就进行按压，并根据他们的 CPR 培训和技能以及受害者的特殊情况考虑是否添加人工呼吸。旁观者 CPR 培训已经发展到纳入这一重点。尽管一般的社区水平 CPR 培训仍然是一个基石策略，但针对最有可能目睹心脏骤停的人群进行培训也具有一定的作用。特别是“及时”的调度员辅助 CPR 指导可以增加旁观者的 CPR 并提高生存的可能性。
旁观者 CPR 的最新进展简化了心脏骤停的识别并改进了 CPR 培训，同时保持了 CPR 的有效性。这些进展的目标是增加和改进旁观者 CPR，进而提高复苏成功率。
