Lwanga Anita, Garcia-Sayan Enrique, Lwanga Steven, Karreman Erwin, Mohamed Amira
Department of Internal Medicine, Sinai Health System, Chicago, Illinois.
Department of Cardiology, Sinai Health System, Chicago, Illinois.
Am J Cardiol. 2017 Jun 15;119(12):1979-1982. doi: 10.1016/j.amjcard.2017.03.023. Epub 2017 Mar 29.
Most studies demonstrate that the use of automated external defibrillators (AEDs) during out of hospital cardiac arrest is associated with survival, but the majority of these studies were performed in large cities. With this in mind, the aims of our study were to examine AED placement and variables associated with survival after nonresidential out of hospital cardiac arrest (NROHCA) in a small North American city. Cases of NROHCA and locations with AEDs, in Regina, between January 2010 and December 2014 were reviewed. Common locations for NROHCA were identified, the frequency of AED availability was determined, and the relations between survival and AED presence, bystander initiated cardiopulmonary resuscitation (CPR), or shockable rhythms were determined. Only 20% of cases of NROHCA had an AED present on the premise. The presence of an AED (p = 0.94) was not associated with survival to the emergency department, whereas bystander initiated CPR (p <0.01) and shockable rhythm (p <0.01) were associated with survival to the emergency department. The presence of an AED (p = 0.86) and bystander initiated CPR (p = 0.06) were not associated with survival to discharge from the hospital, whereas the presence of a shockable rhythm was (p <0.01). Multivariable logistic regression analysis demonstrated that the presence of a shockable rhythm was independently associated with survival to the emergency department (OR 11.78, p <0.01) and discharge from the hospital (OR 6.08, p <0.01). The optimal locations for AED placement in cities of similar size and density may need to be reexamined, as the findings may have implications for public policies surrounding AED placement.
大多数研究表明，在院外心脏骤停期间使用自动体外除颤器（AED）与患者存活相关，但这些研究大多是在大城市进行的。考虑到这一点，我们研究的目的是在北美一个小城市中，检查非住宅院外心脏骤停（NROHCA）后AED的放置情况以及与存活相关的变量。回顾了2010年1月至2014年12月期间里贾纳市NROHCA病例及配备AED的地点。确定了NROHCA的常见地点，测定了AED可用的频率，并确定了存活与AED的存在、旁观者实施的心肺复苏（CPR）或可电击心律之间的关系。只有20%的NROHCA病例现场有AED。AED的存在（p = 0.94）与存活至急诊科无关，而旁观者实施的CPR（p <0.01）和可电击心律（p <0.01）与存活至急诊科相关。AED的存在（p = 0.86）和旁观者实施的CPR（p = 0.06）与存活出院无关，而可电击心律的存在则与之相关（p <0.01）。多变量逻辑回归分析表明，可电击心律的存在与存活至急诊科（比值比11.78，p <0.01）和存活出院（比值比6.08，p <0.01）独立相关。对于规模和密度相似的城市，AED的最佳放置地点可能需要重新审视，因为这些发现可能会对围绕AED放置的公共政策产生影响。
