Ono Yuichi, Hayakawa Mineji, Iijima Hiroaki, Maekawa Kunihiko, Kodate Akira, Sadamoto Yoshihiro, Mizugaki Asumi, Murakami Hiromoto, Katabami Kenichi, Sawamura Atsushi, Gando Satoshi
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Resuscitation. 2016 Oct;107:65-70. doi: 10.1016/j.resuscitation.2016.08.005. Epub 2016 Aug 12.
It is well established that the period of time between a call being made to emergency medical services (EMS) and the time at which the EMS arrive at the scene (i.e. the response time) affects survival outcomes in patients who experience out-of-hospital cardiac arrest (OHCA). However, the relationship between the response time and favourable neurological outcomes remains unclear. We therefore aimed to determine a response time threshold in patients with bystander-witnessed OHCA that is associated with positive neurological outcomes and to assess the relationship between the response time and neurological outcomes in patients with OHCA.
This study was a retrospective, observational analysis of data from 204,277 episodes of bystander-witnessed OHCA between 2006 and 2012 in Japan. We used classification and regression trees (CARTs) and receiver operating characteristic (ROC) curve analyses to determine the threshold of response time associated with favourable neurological outcomes (Cerebral Performance Category 1 or 2) 1 month after cardiac arrest.
Both CARTs and ROC analyses indicated that a threshold of 6.5min was associated with improved neurological outcomes in all bystander-witnessed OHCA events of cardiac origin. Furthermore, bystander cardiopulmonary resuscitation (CPR) prolonged the threshold of response time by 1min (up to 7.5min). The adjusted odds ratio for favourable neurological outcomes in patients with OHCA who received care within ≤6.5min was 1.935 (95% confidential interval: 1.834-2.041, P<0.001).
A response time of ≤6.5min was closely associated with favourable neurological outcomes in all bystander-witnessed patients with OHCA. Bystander CPR prolonged the response time threshold by 1min.
众所周知，从拨打紧急医疗服务（EMS）电话到EMS到达现场的时间段（即响应时间）会影响院外心脏骤停（OHCA）患者的生存结局。然而，响应时间与良好神经功能结局之间的关系仍不明确。因此，我们旨在确定旁观者目击的OHCA患者中与积极神经功能结局相关的响应时间阈值，并评估OHCA患者的响应时间与神经功能结局之间的关系。
本研究是一项对2006年至2012年日本204,277例旁观者目击的OHCA事件数据的回顾性观察分析。我们使用分类与回归树（CART）和受试者工作特征（ROC）曲线分析来确定心脏骤停后1个月与良好神经功能结局（脑功能分类1或2）相关的响应时间阈值。
CART和ROC分析均表明，在所有心脏源性旁观者目击的OHCA事件中，6.5分钟的阈值与改善的神经功能结局相关。此外，旁观者心肺复苏（CPR）将响应时间阈值延长了1分钟（至7.5分钟）。在≤6.5分钟内接受治疗的OHCA患者中，良好神经功能结局的调整优势比为1.935（95%置信区间：1.834 - 2.041，P<0.001）。
在所有旁观者目击的OHCA患者中，≤6.5分钟的响应时间与良好的神经功能结局密切相关。旁观者CPR将响应时间阈值延长了1分钟。
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