Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Emergency Medicine, Inje University College of Medicine, Seoul, South Korea.
Resuscitation. 2014 Jan;85(1):34-41. doi: 10.1016/j.resuscitation.2013.06.004. Epub 2013 Jun 17.
The goal of this study was to determine the effects of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-CPR) on outcomes of out-of-hospital cardiac arrest (OHCA).
All EMS in a metropolitan city with a population of 10 million are dispatched by a single, centralized, and physician-supervised center. Data on patients with adult OHCA with cardiac etiology were collected from the dispatch center registry and from EMS run sheets and hospital medical record review from 2009 to 2011. A standardized DA-CPR protocol (aligned with the 2010 AHA guidelines) we implemented as an intervention in January 2011. The end points were survival to discharge, good neurological outcome, and bystander CPR rate. Multivariate logistic analysis was used to compare between intervention group (2011) and historical control group (2009-2010).
Of 8.144 eligible patients, bystander CPR was performed for the patients in 5.7% (148/2600) of cases in 2009, 6.7% (190/2857) in 2010, and 12.4% (334/2686) in 2011 (p<0.001). The survival to discharge rates was 7.1% (2009), 7.1% (2010), and 9.4% (2011) (p=0.001). Good neurological outcomes occurred in 2.1% (2009), 2.0% (2010), and 3.6% (2011) of cases (p<0.001). The adjusted ORs (95% CIs) for survival to discharge compared with 2009 were 1.33 (1.07-1.66) in 2011 and 1.12 (0.89-1.41) in 2010. The adjusted ORs (95% CIs) for good neurological outcomes were 1.67 (1.13-2.45) in 2011 and 1.13 (0.74-1.72) in 2010.
An EMS intervention using the DA-CPR protocol was associated with a significant increase in bystander CPR and an improved survival and neurologic outcome after OHCA.
本研究旨在探讨调度员辅助的旁观者心肺复苏（DA-CPR）对院外心脏骤停（OHCA）结局的影响。
该市所有的医疗急救服务（EMS）均由一个单一的、集中的、由医师监督的中心进行调度。本研究收集了 2009 年至 2011 年期间，患有心脏病因的成人 OHCA 患者的数据，这些数据来自调度中心的登记处和 EMS 运行表以及医院病历回顾。2011 年 1 月，我们实施了标准化的 DA-CPR 方案（与 2010 年 AHA 指南一致）作为干预措施。终点是存活出院、良好的神经功能结局和旁观者 CPR 率。采用多变量逻辑分析比较干预组（2011 年）和历史对照组（2009-2010 年）。
在 8144 名符合条件的患者中，2009 年有 5.7%（148/2600）的患者进行了旁观者 CPR，2010 年为 6.7%（190/2857），2011 年为 12.4%（334/2686）（p<0.001）。出院存活率分别为 7.1%（2009 年）、7.1%（2010 年）和 9.4%（2011 年）（p=0.001）。良好的神经功能结局分别发生在 2.1%（2009 年）、2.0%（2010 年）和 3.6%（2011 年）的病例中（p<0.001）。与 2009 年相比，2011 年存活出院的调整优势比（95%CI）为 1.33（1.07-1.66），2010 年为 1.12（0.89-1.41）。2011 年良好神经功能结局的调整优势比（95%CI）为 1.67（1.13-2.45），2010 年为 1.13（0.74-1.72）。
使用 DA-CPR 方案的 EMS 干预措施与旁观者 CPR 的显著增加以及 OHCA 后生存率和神经功能结局的改善有关。
