Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, MN, United States.
Allina Health Emergency Medical Services, 167 Grand Avenue, St. Paul, MN, United States.
Resuscitation. 2017 Oct;119:33-36. doi: 10.1016/j.resuscitation.2017.07.031. Epub 2017 Jul 31.
Implementation research that describes how successfully resuscitation guidelines are translated into practice are lacking. We examined whether recent community-based initiatives being conducted as part of the Minnesota Heart Safe (HS) Communities program increase the delivery of CPR and use of automated external defibrillators (AED) by bystanders and first responders prior to ambulance arrival.
Non-EMS witnessed out-of-hospital cardiac arrests (OHCA) with presumed cardiac etiology treated by a single ambulance service in 2013-2015 were studied. Data were obtained from the Minnesota HS program and the Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Registry. Pre-ambulance CPR and AED use within HS communities before and after completion of the program were compared.
As of July 2016, 17 Minnesota communities within the ambulance service area had achieved HS designation and 294 OHCAs that occurred in these communities met inclusion criteria for analysis (120 before HS designation, 174 after). CPR was initiated by bystanders or first responders prior to ambulance arrival in 83% of OHCA events that occurred before HS designation and in 95% of events that occurred after designation (OR=4.23 [1.80-9.98]). Pre-ambulance AED use increased from 63% to 77% after the community intervention (OR=1.94 [1.16-3.24]). Overall unadjusted survival to hospital discharge increased slightly after HS designation, but this difference was not statistically significant (17% vs 20%, p=0.32).
Implementation of the Heart Safe program in communities within our ambulance service area in Minnesota has increased use of CPR and AEDs by bystanders and first responders prior to ambulance arrival.
缺乏描述复苏指南在实践中成功转化的实施研究。我们研究了明尼苏达州心脏安全（HS）社区计划中正在进行的基于社区的新举措是否会增加旁观者和第一反应者在救护车到达之前进行心肺复苏（CPR）和使用自动体外除颤器（AED）的可能性。
研究了 2013-2015 年期间，由单一救护服务机构治疗的具有心脏病因的非急诊医疗服务人员见证的院外心脏骤停（OHCA）。数据来自明尼苏达州 HS 计划和心脏骤停登记以提高生存率（CARES）监测登记。比较了在完成该计划前后 HS 社区内救护车到达前的预救护车 CPR 和 AED 使用情况。
截至 2016 年 7 月，该救护服务区域内的 17 个明尼苏达州社区已获得 HS 认证，在这些社区中发生的 294 例 OHCAs 符合分析标准（120 例在 HS 认证前，174 例在认证后）。在 HS 认证前，有 83%的 OHCA 事件在救护车到达前由旁观者或第一反应者开始进行 CPR，而在认证后，这一比例为 95%（OR=4.23 [1.80-9.98]）。在社区干预后，预救护车 AED 使用从 63%增加到 77%（OR=1.94 [1.16-3.24]）。HS 认证后，总体未经调整的出院生存率略有增加，但差异无统计学意义（17%比 20%，p=0.32）。
在明尼苏达州我们的救护服务区域内的社区实施 Heart Safe 计划增加了旁观者和第一反应者在救护车到达之前进行 CPR 和 AED 的使用。
