Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden.
Section of Cardiology, Stockholm South General Hospital, Stockholm, Sweden.
J Am Heart Assoc. 2017 Oct 4;6(10):e005873. doi: 10.1161/JAHA.117.005873.
Dispatch of basic life support-trained first responders equipped with automated external defibrillators in addition to advanced life support-trained emergency medical services personnel in out-of-hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.
This prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity-matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24-1.57). Thirty-day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05-1.54).
In this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30-day survival.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.
在院外心脏骤停（OHCA）中，派遣除了有高级生命支持培训的紧急医疗服务人员外，还派遣具备基本生命支持培训的第一反应者，加上自动体外除颤器，在一些小型队列研究中与存活率提高有关。本研究的目的是评估在全国范围内，基本生命支持加高级生命支持反应与 OHCA 存活率之间的关系。
这项前瞻性队列研究于 2012 年 1 月 1 日至 2014 年 12 月 31 日进行。与在仅派出紧急医疗服务提供高级生命支持的 12 个县中经历 OHCA 的当代对照组相比，在 9 个瑞典县接受基本生命支持加高级生命支持反应的经历 OHCA 的人被进行了比较。主要结果是 30 天的存活率。分析样本由来自总队列的 7308 个完整病例中的 2786 对（n=5572）组成。干预组中从紧急呼叫到紧急医疗服务或第一反应者到达的中位数时间为 9 分钟，而对照组为 10 分钟（<0.001）。复苏后被收治到医院的患者比例，干预组为 31.4%（875/2786），对照组为 24.9%（694/2786）（条件优势比，1.40；95%置信区间，1.24-1.57）。干预组的 30 天存活率为 9.5%（266/2786），对照组为 7.7%（214/2786）（条件优势比，1.27；95%置信区间，1.05-1.54）。
在这项全国性的干预性试验中，使用倾向评分匹配，在 OHCA 中派遣第一反应者除了紧急医疗服务外，与 30 天存活率的适度但显著增加相关。
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