Johnson M Austin, Grahan Brian J H, Haukoos Jason S, McNally Bryan, Campbell Robert, Sasson Comilla, Slattery David E
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, United States.
Resuscitation. 2014 Jul;85(7):920-6. doi: 10.1016/j.resuscitation.2014.03.044. Epub 2014 Mar 28.
In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations.
We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were older than 1 year of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009 from an arrest presumed to be cardiac in nature. Hierarchical multivariable logistic regression analysis was used to estimate the associations between age, demographic factors, and AED use.
129 patients were 1-8 years of age (younger children), 88 patients were 9-17 years of age (older children), and 19,338 patients were ≥18 years of age (adults). When compared to adults, younger children were less likely to be found in a shockable rhythm (young children 11.6%, adults 23.7%) and were less likely to have an AED used (young children 16.3%, adults 28.3%). Older children had a similar prevalence of shockable rhythms as adults (31.8%) and AED use (20.5%). A multivariable analysis demonstrated that, when compared to adults, younger children had decreased odds of having an AED used (OR 0.42, 95% CI 0.26-0.69), but there was no difference in AED use among older children and adults.
Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.
2005年美国心脏协会发布指南，呼吁在儿科院外心脏骤停期间常规使用自动体外除颤器。本研究的目的是确定在复苏过程中是否遵循了这些指南。
我们对来自参与“提高心脏骤停存活率注册研究（CARES）”的美国29个城市前瞻性收集的数据进行了二次分析。纳入年龄大于1岁且在2005年10月1日至2009年12月31日期间有记录的因疑似心源性骤停而进行复苏尝试的患者。采用分层多变量逻辑回归分析来估计年龄、人口统计学因素与自动体外除颤器使用之间的关联。
129例患者年龄在1 - 8岁（年幼儿童），88例患者年龄在9 - 17岁（年长儿童），19338例患者年龄≥18岁（成人）。与成人相比，年幼儿童出现可电击心律的可能性较小（年幼儿童为11.6%，成人为23.7%），使用自动体外除颤器的可能性也较小（年幼儿童为16.3%，成人为28.3%）。年长儿童出现可电击心律的患病率与成人相似（31.8%），自动体外除颤器的使用率也相似（20.5%）。多变量分析表明，与成人相比，年幼儿童使用自动体外除颤器的几率降低（比值比0.42，95%置信区间0.26 - 0.69），但年长儿童和成人在自动体外除颤器使用方面没有差异。
与成人相比，疑似院外心脏骤停的年幼儿童出现可电击心律的可能性较小，在复苏过程中使用自动体外除颤器的可能性也较小。
