Claesson A, Herlitz J, Svensson L, Ottosson L, Bergfeldt L, Engdahl J, Ericson C, Sandén P, Axelsson C, Bremer A
Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, SE-171 77 Stockholm, Sweden.
Department of Acute and Prehospital Care and Medical Technology, Prehospen - Centre for Prehospital Research, Prehospital Research Centre of Western Sweden, University of Borås, SE-501 90 Borås, Sweden.
Am J Emerg Med. 2017 Aug;35(8):1043-1048. doi: 10.1016/j.ajem.2017.02.030. Epub 2017 Feb 16.
Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.
All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.
Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).
The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.
旁观者在院外心脏骤停（OHCA）的公众可获取除颤（PAD）中起着至关重要的作用。急救人员（FR）与紧急医疗服务（EMS）的双重调度可减少首次除颤时间。本研究的目的是描述在EMS到达之前OHCA中自动体外除颤器（AED）的使用情况。
2008年至2015年期间在瑞典西部，所有在EMS到达之前使用AED且心律可电击的OHCA病例均符合纳入标准。使用瑞典心肺复苏登记册（SRCR）的数据进行分析，在最终分析中将现场旁观者和FR除颤与EMS除颤进行比较。
在报告的6675例病例中，24%发生心室颤动（VF），在所有VF病例中，162例患者（15%）在EMS到达之前接受了除颤，其中46%使用了现场公共AED。EMS到达之前接受除颤的病例比例从2008年的5%增加到2015年的20%（p<0.001）。在此期间，VF患者的30天生存率从22%提高到28%（p=0.04），当现场使用AED时生存率最高（68%），从心脏骤停到除颤的中位延迟为6.5分钟。现场除颤与调度除颤相比，30天生存的调整优势比为2.45（95%CI：1.02-5.95）。
随着时间的推移，EMS到达之前AED的使用有所增加。这与VF患者30天生存率的提高相关。EMS到达之前现场使用AED时30天生存率最高。
