Nishi Taiki, Takei Yutaka, Kamikura Takahisa, Ohta Keisuke, Hashimoto Masaaki, Inaba Hideo
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan.
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan; Department of Medical Science and Technology, Hiroshima International University, Higashi-hiroshima, Hiroshima Japan.
Am J Emerg Med. 2015 Jan;33(1):43-9. doi: 10.1016/j.ajem.2014.10.018. Epub 2014 Oct 18.
The aim of the study was to determine the quality of basic life support (BLS) in out-of-hospital cardiac arrests (OHCAs) receiving bystander cardiopulmonary resuscitation (CPR) and public automated external defibrillator (AED) application.
From January 2006 to December 2012, data were prospectively collected from OHCA) and impending cardiac arrests treated with and without public AED before emergency medical technician (EMT) arrival. Basic life support actions and outcomes were compared between cases with and without public AED application. Interruptions of CPR were compared between 2 groups of AED users: health care provider (HCP) and non-HCP.
Public AEDs were applied in 10 and 273 cases of impending cardiac arrest and non-EMT-witnessed OHCAs, respectively (4.3% of 6407 non-EMT-witnessed OHCAs). Defibrillation was delivered to 33 (13.3%) cases. Public AED application significantly improved the rate of 1-year neurologically favorable survival in bystander CPR-performed cases with shockable initial rhythm but not in those with nonshockable rhythm. Emergency calls were significantly delayed compared with other OHCAs without public AED application (median: 3 and 2 minutes, respectively; P < .0001). Analysis of AED records obtained from 136 (54.6%) of the 249 cases with AED application revealed significantly lower rate of compressions delivered per minute and significantly greater proportion of CPR pause in the non-HCP group. Time interval between power on and the first electrocardiographic analysis widely varied in both groups and was significantly prolonged in the non-HCP group (P = .0137).
Improper BLS responses were common in OHCAs treated with public AEDs. Periodic training for proper BLS is necessary for both HCPs and non-HCPs.
本研究旨在确定接受旁观者心肺复苏（CPR）和公共自动体外除颤器（AED）应用的院外心脏骤停（OHCA）患者的基本生命支持（BLS）质量。
2006年1月至2012年12月，前瞻性收集在紧急医疗技术人员（EMT）到达之前接受或未接受公共AED治疗的OHCA及即将发生心脏骤停患者的数据。比较应用和未应用公共AED的病例之间的基本生命支持行动和结果。比较两组AED使用者（医疗保健提供者[HCP]和非HCP）之间的CPR中断情况。
公共AED分别应用于10例即将发生心脏骤停和273例非EMT目击的OHCA患者（占6407例非EMT目击OHCA的4.3%）。33例（13.3%）患者接受了除颤。公共AED的应用显著提高了初始心律可电击的旁观者实施CPR病例的1年神经功能良好生存率，但对初始心律不可电击的病例没有影响。与未应用公共AED的其他OHCA相比，急救电话明显延迟（中位数分别为3分钟和2分钟；P <.0001）。对249例应用AED病例中的136例（54.6%）的AED记录分析显示，非HCP组每分钟按压次数明显较低，CPR暂停比例明显更高。两组从开机到首次心电图分析的时间间隔差异很大，非HCP组明显延长（P = 0.0137）。
在接受公共AED治疗的OHCA患者中，BLS反应不当很常见。对HCP和非HCP都需要进行定期的正确BLS培训。
