Department of Sports Medicine, Kokushikan University, Japan; Research Institute of Disaster Management and EMS, Kokushikan University, Japan.
Department of EMS Systems, Graduate School, Kokushikan University, Japan.
Am J Emerg Med. 2018 Mar;36(3):384-391. doi: 10.1016/j.ajem.2017.08.034. Epub 2017 Aug 16.
We investigated whether DA-CPR would have the same effect as spontaneously-delivered bystander CPR.
A total of 37,899 witnessed cardiogenic out of hospital cardiac arrest (OHCA) selected from a nationwide Utstein-Japanese database between 2008 and 2012. Patients were divided into four groups as follows: CPR initiated with dispatcher assistance (DA-CPR; n=10,424), no CPR provided with dispatcher assistance (DA-No CPR; n=4658), spontaneously-delivered bystander CPR provided without DA (BCPR; n=6630), and both BCPR and dispatcher assistance was not provided (No BCPR-No DA; n=16,187). The primary endpoint was rate of shockable rhythm on the initial ECG, return of spontaneous circulation (ROSC) on the field. A multivariable logistic regression analysis was used. Adjusted odds ratios (AOR) are presented as 95% confidence intervals (95% CIs) among the groups.
The rate of DA-CPR implementation has gradually increased since 2005. In comparison with DA-No CPR, both spontaneously-delivered BCPR and DA-CPR were significantly associated with the following factors: increased rate of shockable rhythm on the initial ECG (AOR, 1.75 and 1.72; 95% CI, 1.67 to 1.85 and 1.63 to 1.83),improved field ROSC (AOR, 1.42 and 1.40; 95% CI, 1.33 to 1.52 and 1.30 to 1.51) and 1-month favorable neurological outcomes (AOR, 1.72 and 1.80; 95% CI, 1.59 to 1.88 and 1.64 to 1.97), respectively.
We found that the spontaneously delivered BCPR group showed favorable results. In comparison to the DA-No BCPR group, DA-CPR group resulted in the nearly equivalent effect as spontaneously-delivered BCPR group. Further standard dispatcher education is indicated.
我们旨在研究是否有证据表明，由急救员辅助实施的心肺复苏术（以下简称“DA-CPR”）与由旁观者自发实施的心肺复苏术（以下简称“BCPR”）具有相同的效果。
我们从 2008 年至 2012 年期间全国性的 Utstein-Japanese 数据库中，总共选取了 37899 例目击的院外心源性心脏骤停（OHCA）患者。患者被分为以下四组：有急救员辅助的 CPR（以下简称“DA-CPR”；n=10424）、无急救员辅助的 CPR（以下简称“DA-No CPR”；n=4658）、无急救员辅助但由旁观者自发实施的 CPR（以下简称“BCPR”；n=6630）以及既无 BCPR 也无 DA 提供的 CPR（以下简称“无 BCPR-无 DA”；n=16187）。主要终点为初始心电图上的可除颤性节律的比率、现场自主循环恢复（ROSC）的比率。我们采用多变量逻辑回归分析。调整后的优势比（AOR）以组间 95%置信区间（95% CI）表示。
自 2005 年以来，DA-CPR 的实施率逐渐增加。与 DA-No CPR 相比，自发实施的 BCPR 和 DA-CPR 与以下因素显著相关：初始心电图上的可除颤性节律比率增加（AOR 为 1.75 和 1.72；95%CI 为 1.67 至 1.85 和 1.63 至 1.83）、现场 ROSC 改善（AOR 为 1.42 和 1.40；95%CI 为 1.33 至 1.52 和 1.30 至 1.51）以及 1 个月后的良好神经功能预后（AOR 为 1.72 和 1.80；95%CI 为 1.59 至 1.88 和 1.64 至 1.97）。
我们发现，自发实施的 BCPR 组显示出良好的效果。与 DA-No BCPR 组相比，DA-CPR 组的效果几乎等同于自发实施的 BCPR 组。因此，需要进一步开展标准化的急救员教育。
