Spaite D W, Hanlon T, Criss E A, Valenzuela T D, Wright A L, Keeley K T, Meislin H W
Arizona Emergency Medicine Research Center, College of Medicine, Tucson.
Ann Emerg Med. 1990 Nov;19(11):1264-9. doi: 10.1016/s0196-0644(05)82285-1.
Numerous studies have shown initiation of bystander CPR to significantly improve survival from prehospital cardiac arrest. However, in emergency medical services (EMS) systems with very short response times, bystander CPR has not been shown to impact outcome. The purpose of this study was to determine the effect of bystander CPR on survival from out-of-hospital cardiac arrest in such a system.
Prehospital, hospital, and death certificate data from a medium-sized metropolitan area were retrospectively analyzed for adult, nontraumatic cardiac arrest during a 16-month period.
A total of 298 patients met study criteria. One hundred ninety-five arrests (65.4%) were witnessed, and 103 (34.6%) were unwitnessed. Twenty-five witnessed victims (12.8%) were discharged alive, whereas no unwitnessed victims survived (P less than .001). Patients suffering a witnessed episode of ventricular fibrillation/tachycardia (VF/VT) were more likely to survive (21.9%) than were other patients (2.0%, P less than .0001). Among witnessed patients, initiation of bystander CPR was associated with a significant improvement in survival (20.0%) compared with the no-bystander CPR group (9.2%, P less than .05). Bystander CPR was also associated with improved outcome when witnessed patients with successful prehospital resuscitation were evaluated as a group; 18 had bystander CPR, of whom 13 (72.2%) survived compared with only 12 of 38 patients with no bystander CPR (31.6%, P less than .01).
Our data revealed improved survival rates when bystander CPR was initiated on victims of witnessed cardiac arrest in an EMS system with short response times.
大量研究表明，旁观者实施心肺复苏（CPR）能显著提高院外心脏骤停患者的生存率。然而，在响应时间极短的紧急医疗服务（EMS）系统中，旁观者CPR对患者预后并无影响。本研究旨在确定在这样一个系统中，旁观者CPR对院外心脏骤停患者生存的影响。
对一个中等规模大都市地区在16个月期间内成年非创伤性心脏骤停患者的院前、医院及死亡证明数据进行回顾性分析。
共有298例患者符合研究标准。其中195例（65.4%）心脏骤停为有目击者，103例（34.6%）为无目击者。25例有目击者的患者（12.8%）存活出院，而无目击者的患者无一存活（P<0.001）。发生心室颤动/室性心动过速（VF/VT）且有目击者的患者比其他患者更有可能存活（21.9%）（其他患者为2.0%，P<0.0001）。在有目击者的患者中，与无旁观者实施CPR的组相比，旁观者实施CPR与生存率显著提高相关（20.0%）（无旁观者实施CPR组为9.2%，P<0.05）。当将成功进行院前复苏的有目击者患者作为一组进行评估时，旁观者CPR也与更好的预后相关；18例有旁观者实施CPR，其中13例（72.2%）存活，而38例无旁观者实施CPR的患者中只有12例（31.6%）存活（P<0.01）。
我们的数据显示，在响应时间短的EMS系统中，对有目击者的心脏骤停患者实施旁观者CPR可提高生存率。
