Park Gwan Jin, Song Kyoung Jun, Shin Sang Do, Lee Kyung Won, Ahn Ki Ok, Lee Eui Jung, Hong Ki Jeong, Ro Young Sun
Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
Inje University Seoul Paik Hospital, Department of Emergency Medicine, Republic of Korea.
Am J Emerg Med. 2017 Aug;35(8):1049-1055. doi: 10.1016/j.ajem.2017.02.033. Epub 2017 Feb 16.
This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response.
A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (<4min), fast group (4 to <8min), late group (8 to <15min), and latest group (15 to <30min). The primary outcome was hospital discharge and the secondary outcome was survival with good neurological outcome. Multivariable logistic regression analysis was performed to evaluate the interaction between bystander CPR and the time interval from collapse to CPR by EMS providers.
A total of 15,354 OHCAs were analyzed. Bystander CPR was performed in 8591 (56.0%). Survival to hospital discharge occurred in 1632 (10.6%) and favorable neurological outcome in 996 (6.5%). In an interaction model of bystander CPR, compared to the fastest group, adjusted odds ratios (AORs) (95% CIs) for survival to discharge were 0.89 (0.66-1.20) in the fast group, 0.76 (0.57-1.02) in the late group, and 0.52 (0.37-0.73) in the latest group. For favorable neurological outcome, AORs were 1.12 (0.77-1.62) in the fast group, 0.90 (0.62-1.30) in the late group, 0.59 (0.38-0.91) in the latest group.
The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR.
本研究旨在确定旁观者心肺复苏术（CPR）对从心脏骤停至急救医疗服务（EMS）响应时间不断增加的患者临床结局的影响。
对2012年至2014年期间因疑似心脏病因导致的院外心脏骤停（OHCA）且有目击者的患者进行了一项基于人群的观察性研究。将EMS提供者从心脏骤停至进行CPR的时间间隔分为四分位组：最快组（<4分钟）、快组（4至<8分钟）、晚组（8至<15分钟）和最晚组（15至<30分钟）。主要结局是出院，次要结局是存活且神经功能良好。进行多变量逻辑回归分析以评估旁观者CPR与EMS提供者从心脏骤停至进行CPR的时间间隔之间的相互作用。
共分析了15354例OHCA。8591例（56.0%）进行了旁观者CPR。1632例（10.6%）存活至出院，996例（6.5%）神经功能良好。在旁观者CPR的相互作用模型中，与最快组相比，快组出院存活的调整优势比（AORs）（95%置信区间）为0.89（0.66 - 1.20），晚组为0.76（0.57 - 1.02），最晚组为0.52（0.37 - 0.73）。对于神经功能良好的结局，快组的AORs为1.12（0.77 - 1.62），晚组为0.90（0.62 - 1.30），最晚组为0.59（0.38 - 0.91）。
随着救护车响应时间的增加，OHCA患者的存活率降低。在接受旁观者CPR的患者中，死亡率的增加和神经功能结局的恶化似乎得到了缓解。
