Department of Emergency Medicine, University of British Columbia, Canada; St. Paul's Hospital, Vancouver, B.C., Canada; Providence Healthcare Research Institute, Vancouver, B.C., Canada.
St. Paul's Hospital, Vancouver, B.C., Canada; The Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan.
Resuscitation. 2018 Apr;125:118-125. doi: 10.1016/j.resuscitation.2018.01.049. Epub 2018 Feb 3.
British Columbia (BC) Emergency Health Services implemented a strategy to improve outcomes for out-of-hospital cardiac arrest (OHCA), focusing on paramedic-led high-quality on-scene resuscitation. We measured changes in care metrics and survival trends.
This was a post-hoc study of prospectively identified consecutive non-traumatic ambulance-treated adult OHCAs from 2006 to 2016 within BC's four metropolitan areas. The primary outcome was survival to hospital discharge; we also described available favourable neurological outcomes (mRS ≤3). We tested the significance of year-by-year trends in baseline characteristics, and calculated risk-adjusted survival rates using multivariable Poisson regression.
We included 15 145 patients. In univariate analyses there were significant increases in bystander CPR, chest compression fraction, advanced life support attendance, duration of resuscitation until advanced airway placement, duration of resuscitation until termination, and overall scene time. There was a significant decrease in initial shockable rhythms, bystander witnessed arrests, and transports initiated prior to ROSC. Survival and the proportion of survivors with favourable neurological outcomes increased significantly. In adjusted analyses, there was an improvement in return of spontaneous circulation (risk-adjusted rate 41% in 2006 to 51% in 2016; adjusted rate ratio per year 1.02, 95% CI 1.01-1.02, p < 0.01 for trend) and survival at hospital discharge (risk-adjusted rate 8.6% in 2006 to 16% in 2016; adjusted rate ratio per year 1.05, 95% CI 1.04-1.06, p < 0.01 for trend).
From 2006 to 2016 BC's provincial ambulance system prioritized paramedic-led on-scene resuscitation, during which time there were significant improvements in patient outcomes. Our data may assist other systems, providing a model for prehospital resuscitation quality improvement.
不列颠哥伦比亚省（BC）紧急医疗服务实施了一项策略，以改善院外心脏骤停（OHCA）的治疗效果，重点是护理人员主导的高质量现场复苏。我们测量了治疗指标和生存趋势的变化。
这是一项回顾性研究，对 2006 年至 2016 年期间不列颠哥伦比亚省四个大都市区的连续非创伤性救护车治疗的成年 OHCA 进行了前瞻性识别。主要结局是存活至出院；我们还描述了可用的有利神经结局（mRS ≤3）。我们测试了逐年基线特征趋势的显著性，并使用多变量泊松回归计算了风险调整后的生存率。
我们纳入了 15145 例患者。在单变量分析中，旁观者心肺复苏、胸外按压比例、高级生命支持的参与率、从开始复苏到建立高级气道的时间、从开始复苏到终止的时间以及整个现场时间均有显著增加。初始可除颤节律、旁观者目击发作和在恢复自主循环前开始转运的比例显著下降。存活率和有良好神经结局的幸存者比例均显著提高。在调整分析中，自主循环恢复的情况有所改善（2006 年的风险调整率为 41%，2016 年为 51%；调整后每年的比率为 1.02，95%CI 为 1.01-1.02，p<0.01），出院时的存活率（2006 年的风险调整率为 8.6%，2016 年为 16%；调整后每年的比率为 1.05，95%CI 为 1.04-1.06，p<0.01）。
从 2006 年到 2016 年，BC 省的省级救护车系统优先考虑护理人员主导的现场复苏，在此期间，患者的治疗效果有了显著的提高。我们的数据可能有助于其他系统，为院前复苏质量的提高提供了一个模型。
