Fukushima Hidetada, Imanishi Masami, Iwami Taku, Seki Tadahiko, Kawai Yasuyuki, Norimoto Kazunobu, Urisono Yasuyuki, Hata Michiaki, Nishio Kenji, Saeki Keigo, Kurumatani Norio, Okuchi Kazuo
Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan.
Department of Neurosurgery, Nara Saiseikai Gose Hospital, Gose, Nara, Japan.
Emerg Med J. 2015 Apr;32(4):314-7. doi: 10.1136/emermed-2013-203112. Epub 2014 Jan 8.
Current guidelines for cardiopulmonary resuscitation (CPR) emphasise that emergency medical service (EMS) dispatchers should identify sudden cardiac arrest (CA) with abnormal breathing and assist lay rescuers performing CPR. However, lay rescuers description of abnormal breathing may be inconsistent, and it is unclear how EMS dispatchers provide instruction for CPR based on the breathing status of the CA victims described by laypersons.
To investigate the incidence of abnormal breathing and the association between the EMS dispatcher-assisted CPR instruction and layperson CPR, we retrospectively analysed 283 witnessed CA cases whose information regarding breathing status of CA victims was available from population-based prospective cohort data. In 169 cases (59.7%), laypersons described that the CA victims were breathing in various ways, and that the victims were 'not breathing' in 114 cases (40.3%). Victims described as breathing in various ways were provided EMS dispatch-instruction for CPR less frequently than victims described as 'not breathing' (27.8% (47/169) vs 84.2% (96/114); p<0.001). Multivariate logistic regression showed that EMS dispatch-instruction for CPR was associated significantly with layperson CPR (adjusted OR, 11.0; 95% CI, 5.72 to 21.2).
This population-based study indicates that 60% of CA victims showed agonal respiration, which was described as breathing in various ways at the time of EMS call. Although EMS dispatch-instruction was associated significantly with an increase in layperson CPR, abnormal breathing was associated with a much lower rate of CPR instruction and, in turn, was related to a much lower rate of bystander CPR.
当前的心肺复苏（CPR）指南强调，紧急医疗服务（EMS）调度员应识别呼吸异常的心脏骤停（CA）情况，并协助非专业救援人员进行心肺复苏。然而，非专业救援人员对异常呼吸的描述可能不一致，并且尚不清楚EMS调度员如何根据非专业人员描述的心脏骤停受害者的呼吸状况提供心肺复苏指导。
为了调查异常呼吸的发生率以及EMS调度员协助的心肺复苏指导与非专业人员心肺复苏之间的关联，我们回顾性分析了283例有目击的心脏骤停病例，这些病例的心脏骤停受害者呼吸状况信息来自基于人群的前瞻性队列数据。在169例（59.7%）病例中，非专业人员描述心脏骤停受害者有各种呼吸方式，而在114例（40.3%）病例中，受害者被描述为“没有呼吸”。被描述为有各种呼吸方式的受害者接受EMS调度员心肺复苏指导的频率低于被描述为“没有呼吸”的受害者（27.8%（47/169）对84.2%（96/114）；p<0.001）。多因素逻辑回归显示，EMS调度员的心肺复苏指导与非专业人员的心肺复苏显著相关（调整后的比值比，11.0；95%置信区间，5.72至21.2）。
这项基于人群的研究表明，60%的心脏骤停受害者表现出濒死呼吸，在拨打EMS电话时被描述为有各种呼吸方式。尽管EMS调度员的指导与非专业人员心肺复苏的增加显著相关，但异常呼吸与更低的心肺复苏指导率相关，进而与更低的旁观者心肺复苏率相关。
