Malta Hansen Carolina, Rosenkranz Simone Mørk, Folke Fredrik, Zinckernagel Line, Tjørnhøj-Thomsen Tine, Torp-Pedersen Christian, Sondergaard Kathrine B, Nichol Graham, Hulvej Rod Morten
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
Duke Clinical Research Institute, Duke University, Durham, NC.
J Am Heart Assoc. 2017 Mar 13;6(3):e004572. doi: 10.1161/JAHA.116.004572.
Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest.
One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders to consecutive out-of-hospital cardiac arrest, where an AED was present were conducted (from January 2012 to April 2015, in Denmark). Purposive maximum variation sampling was used to establish the breadth of the bystander perspective. Twenty-six of the 128 interviews were chosen for further in-depth analyses, until data saturation. We used cross-sectional indexing (using software), and inductive in-depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands-on CPR training, the following were described as facilitators: prior knowledge that intervention is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands-on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral obligation to act.
Several factors other than previous hands-on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out-of-hospital cardiac arrest.
尽管心肺复苏术（CPR）培训广泛开展且自动体外除颤器（AED）得以普及，但许多院外心脏骤停患者仍无法获得旁观者的干预（心肺复苏或除颤）。我们试图调查在一组曾接受过心肺复苏技术培训且在场目睹院外心脏骤停的旁观者中，哪些因素会促使他们实施心肺复苏并使用自动体外除颤器。
对丹麦连续发生的院外心脏骤停且现场配备自动体外除颤器的旁观者进行了128次半结构化定性访谈（2012年1月至2015年4月）。采用目的抽样中的最大变异抽样法以全面了解旁观者的观点。从128次访谈中选取26次进行进一步深入分析，直至数据饱和。我们使用横断面索引（借助软件）和归纳性深入主题分析来确定那些促进心肺复苏和自动体外除颤器使用的因素。除了先前的实际心肺复苏培训外，以下因素也被描述为促进因素：事先了解干预对提高生存率至关重要、不会造成重大伤害，以及自动体外除颤器会在心肺复苏过程中提供指导；先前接受过自动体外除颤器使用的实际培训；在进行心肺复苏时，团队合作（即支持）、使用自动体外除颤器语音提示和通气面罩，以及展现领导力并感到有采取行动的道德义务。
除了先前的实际心肺复苏培训外，还有其他几个因素促进了旁观者对心肺复苏和自动体外除颤器的使用。认识并改变这些因素可能会提高院外心脏骤停后旁观者实施心肺复苏的比例以及患者的生存率。
