美国院外儿童心脏骤停后旁观者心肺复苏与整体和神经功能良好生存的关联：来自心脏骤停登记以加强生存监测登记的报告。

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry.

机构信息

The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.

Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.

出版信息

JAMA Pediatr. 2017 Feb 1;171(2):133-141. doi: 10.1001/jamapediatrics.2016.3643.

DOI:10.1001/jamapediatrics.2016.3643

PMID:27837587

Abstract

IMPORTANCE

There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.

OBJECTIVE

To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).

DESIGN, SETTING, AND PARTICIPANTS: This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.

EXPOSURES

Bystander CPR, which included conventional CPR and compression-only CPR.

MAIN OUTCOMES AND MEASURES

Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.

RESULTS

Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (P < .001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.

CONCLUSIONS AND RELEVANCE

Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.

摘要

重要性

关于 18 岁及以下儿童旁观者心肺复苏术（BCPR）的流行率或结局的数据很少。

目的

描述儿科院外心脏骤停（OHCA）中的 BCPR。

设计、设置和参与者：对 2013 年 1 月至 2015 年 12 月期间的心脏骤停登记数据库进行了这项分析，研究对象为 18 岁以下非创伤性 OHCA 患儿。

暴露

旁观者 CPR，包括传统 CPR 和单纯按压 CPR。

主要结果和措施

整体生存率和神经功能良好的生存率，定义为出院时的脑功能分类评分 1 或 2。

结果

在 3900 名年龄小于 18 岁的 OHCA 患儿中，2317 名（59.4%）为婴儿，2346 名（60.2%）为女性，3595 名（92.2%）为非颤动手律。1814 名儿童（46.5%）进行了旁观者 CPR，与非裔美国儿童（447 名，占 1134 名儿童的 39.4%）和西班牙裔儿童（197 名，占 455 名儿童的 43.3%）相比，白人儿童更常进行旁观者 CPR（687 名，占 1221 名儿童的 56.3%）（P < .001）。整体生存率和神经功能良好的生存率分别为 11.3%（440 名，占 3900 名儿童）和 9.1%（354 名，占 3900 名儿童）。多变量分析显示，BCPR 与整体生存率的提高独立相关（调整后比例为 13.2%；95%CI，11.81-14.58；调整后比值比，1.57；95%CI，1.25-1.96）和神经功能良好的生存率（调整后比例为 10.3%；95%CI，9.10-11.54；调整后比值比，1.50；95%CI，1.21-1.98），与没有 BCPR 相比（整体生存率：调整后比例为 9.5%；95%CI，8.28-10.69；神经功能良好的生存率：调整后比例为 7.59%；95%CI，6.50-8.68）。对于那些有 BCPR 类型数据的人，1411 人中 697 人（49.4%）接受了传统 CPR，1411 人中 714 人（50.6%）接受了单纯按压 CPR。多变量分析显示，只有传统 CPR（调整后比例为 12.89%；95%CI，10.69-15.09；调整后比值比，2.06；95%CI，1.51-2.79）与没有 BCPR（调整后比例为 9.59%；95%CI，6.45-8.61）相比，与神经功能良好的生存率提高有关。存在 BCPR 与年龄的显著交互作用。在婴儿中，传统 BCPR 与整体生存率和神经功能良好的生存率提高有关，而单纯按压 CPR 与无 BCPR 的结局相似。