2005 年复苏指南实施前后的心脏骤停结局：是否有改善的证据？
Cardiac arrest outcomes before and after the 2005 resuscitation guidelines implementation: evidence of improvement?
机构信息
Ambulance Victoria, Australia.
出版信息
Resuscitation. 2011 Aug;82(8):984-8. doi: 10.1016/j.resuscitation.2011.04.005. Epub 2011 Apr 16.
BACKGROUND
Previous studies have reported improvements in out-of-hospital cardiac arrest (OHCA) outcomes with the introduction of the 2005 cardiopulmonary resuscitation guidelines however they have not adjusted for underlying trends in OHCA survival. We compare outcomes before and after the 2005 guideline changes adjusting for underlying trends in OHCA survival.
METHODS
The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for adult (≥16 years) OHCA of presumed cardiac aetiology, unwitnessed by paramedics with attempted resuscitation. Outcomes for OHCA occurring between 2003 and 2005 were compared with 2007-2009. Segmented regression analysis of interrupted time series data was performed, adjusting for known predictors, to examine changes in survival to hospital and survival to hospital discharge.
RESULTS
For the pre- and post- guideline periods there were 3115 and 3248 OHCAs, respectively. Asystole increased as presenting rhythm (33-43%, p<0.001) as did median EMS response times (7.1-7.8 min, p<0.001) over the two periods. VF/VT arrests decreased (40-35.5%, p=0.001) as did bystander witnessed arrests (63-59%, p=0.002). On univariate analysis survival to hospital discharge improved between the two periods (9.4-11.8%, p=0.002) due to improved outcomes in VF/VT (19-28%, p<0.001). Segmented regression analysis of interrupted time series data showed improvement in the rate of survival to get to hospital for shockable and non-shockable rhythms [OR (95% CI)=1.54 (1.10-2.15, p=0.01) and 1.45 (1.10-2.00, p=0.02), respectively] following implementation of the guidelines however survival to hospital discharge did not improve [OR=1.07 (0.70-1.62, p=0.70) and 1.40 (0.69-2.85, p=0.40), respectively].
CONCLUSIONS
OHCA outcomes have improved since introduction of the 2005 CPR guidelines, but multivariable segmented regression analysis adjusting for pre-existing trends in survival suggests that this improvement may not be due to implementation of the 2005 resuscitation guidelines.
背景
先前的研究报告指出，2005 年心肺复苏指南的推出改善了院外心脏骤停（OHCA）的结局，但并未调整 OHCA 存活率的潜在趋势。我们比较了 2005 年指南变化前后的结果，同时调整了 OHCA 存活率的潜在趋势。
方法
搜索维多利亚救护车心脏骤停登记处（VACAR），以寻找推定心源性病因、未经急救人员见证且尝试复苏的成年（≥16 岁）OHCA。比较 2003 年至 2005 年和 2007 年至 2009 年之间的 OHCA 结局。使用分段回归分析中断时间序列数据，调整已知预测因素，以检查存活到医院和存活到出院的变化。
结果
在指南前后期间，分别有 3115 例和 3248 例 OHCA。随着呈现节律的变化（33-43%，p<0.001），以及 EMS 反应时间中位数（7.1-7.8 分钟，p<0.001）的增加，心搏骤停的比例增加。VF/VT 骤停减少（40-35.5%，p=0.001），旁观者见证的骤停也减少（63-59%，p=0.002）。在单变量分析中，由于 VF/VT 的结果改善（19-28%，p<0.001），两个时期之间存活到出院的比例有所提高（9.4-11.8%，p=0.002）。中断时间序列数据的分段回归分析显示，在实施指南后，可电击和非可电击节律的存活到医院的比例有所提高[比值比（95%置信区间）=1.54（1.10-2.15，p=0.01）和 1.45（1.10-2.00，p=0.02）]，但存活到出院的比例没有提高[比值比=1.07（0.70-1.62，p=0.70）和 1.40（0.69-2.85，p=0.40）]。
结论
自 2005 年心肺复苏指南推出以来，OHCA 的结局有所改善，但多变量分段回归分析调整了生存的预先存在的趋势表明，这一改善可能不是由于实施了 2005 年复苏指南。
Zotero 插件