Ro Young Sun, Shin Sang Do, Lee Yu Jin, Lee Seung Chul, Song Kyoung Jun, Ryoo Hyun Wook, Ong Marcus Eng Hock, McNally Bryan, Bobrow Bentley, Tanaka Hideharu, Myklebust Helge, Birkenes Tonje Søraas
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Ann Emerg Med. 2017 Jan;69(1):52-61.e1. doi: 10.1016/j.annemergmed.2016.07.028. Epub 2016 Sep 21.
We study the effect of a nationwide dispatcher-assisted cardiopulmonary resuscitation (CPR) program on out-of-hospital cardiac arrest outcomes by arrest location (public and private settings).
All emergency medical services (EMS)-treated adults in Korea with out-of-hospital cardiac arrests of cardiac cause were enrolled between 2012 and 2013, excluding cases witnessed by EMS providers and those with unknown outcomes. Exposure was bystander CPR categorized into 3 groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no bystander CPR. The endpoint was good neurologic recovery at discharge. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across settings.
A total of 37,924 patients (31.1% bystander CPR with dispatcher assistance, 14.3% bystander CPR without dispatcher assistance, and 54.6% no bystander CPR) were included in the final analysis. The total bystander CPR rate increased from 30.9% in quarter 1 (2012) to 55.7% in quarter 4 (2014). Bystander CPR with and without dispatcher assistance was more likely to result in higher survival with good neurologic recovery (4.8% and 5.2%, respectively) compared with no bystander CPR (2.1%). The adjusted odds ratios for good neurologic recovery were 1.50 (95% confidence interval [CI] 1.30 to 1.74) in bystander CPR with dispatcher assistance and 1.34 (95% CI 1.12 to 1.60) in bystander CPR without it compared with no bystander CPR. For arrests in private settings, the adjusted odds ratios were 1.58 (95% CI 1.30 to 1.92) in bystander CPR with dispatcher assistance and 1.28 (95% CI 0.98 to 1.67) in bystander CPR without it; in public settings, the adjusted odds ratios were 1.41 (95% CI 1.14 to 1.75) and 1.37 (95% CI 1.08 to 1.72), respectively.
Bystander CPR regardless of dispatcher assistance was associated with improved neurologic recovery after out-of-hospital cardiac arrest. However, for out-of-hospital cardiac arrest cases in private settings, bystander CPR was associated with improved neurologic recovery only when dispatcher assistance was provided.
我们研究了一项全国性的调度员辅助心肺复苏（CPR）计划对院外心脏骤停患者按骤停地点（公共场所和私人场所）划分的结局的影响。
纳入2012年至2013年期间韩国所有因心脏原因发生院外心脏骤停且接受紧急医疗服务（EMS）治疗的成年人，排除EMS提供者目睹的病例以及结局未知的病例。暴露因素为旁观者实施的心肺复苏，分为3组：有调度员协助的旁观者心肺复苏、无调度员协助的旁观者心肺复苏和无旁观者心肺复苏。终点为出院时神经功能良好恢复。进行了多变量逻辑回归分析。对带有交互项的最终模型进行评估，以比较不同场所的影响。
最终分析纳入了总共37924例患者（31.1%为有调度员协助的旁观者心肺复苏，14.3%为无调度员协助的旁观者心肺复苏，54.6%为无旁观者心肺复苏）。旁观者心肺复苏的总发生率从2012年第一季度的30.9%升至2014年第四季度的55.7%。与无旁观者心肺复苏（2.1%）相比，有和无调度员协助的旁观者心肺复苏更有可能带来更高的神经功能良好恢复的生存率（分别为4.8%和5.2%）。有调度员协助的旁观者心肺复苏中神经功能良好恢复的校正比值比为1.50（95%置信区间[CI]1.30至1.74），无调度员协助的旁观者心肺复苏中为1.34（95%CI1.12至1.60）。对于私人场所发生的心脏骤停，有调度员协助的旁观者心肺复苏的校正比值比为1.58（95%CI1.30至1.92），无调度员协助的旁观者心肺复苏中为1.28（95%CI0.98至1.67）；在公共场所，校正比值比分别为1.41（95%CI1.14至1.75）和1.37（95%CI1.08至1.72）。
无论有无调度员协助，旁观者心肺复苏都与院外心脏骤停后神经功能恢复改善相关。然而，对于私人场所发生的院外心脏骤停病例，只有在提供调度员协助时，旁观者心肺复苏才与神经功能恢复改善相关。
