Johns Hopkins University School of Medicine, Baltimore, MD (R.A.P., M.W.).
Department of Biostatistics (S.P.B.).
Circulation. 2018 May 15;137(20):2104-2113. doi: 10.1161/CIRCULATIONAHA.117.030700. Epub 2018 Feb 26.
Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA.
From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure.
Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer.
Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.
院外心脏骤停（OHCA）伴有可电击性节律的患者，早期除颤可提高生存率。尽管可电击性 OHCA 仅占总体心脏骤停的 ≈25%，但 ≈60%的公共场所 OHCA 是可电击性的，这为通过旁观者早期除颤使数千人完全康复提供了可能性。我们旨在确定旁观者使用自动体外除颤器与可电击性观察到的公共场所 OHCA 患者的生存率和功能结局的关系。
2011 年至 2015 年，复苏结果联合会前瞻性地收集了 9 个区域中心所有心脏骤停的详细信息。暴露因素为旁观者应用自动体外除颤器进行电击与紧急医疗服务初始除颤相比。主要结局测量指标是出院时功能正常或接近正常（有利）的生存状态，定义为改良 Rankin 评分≤2。出院时的生存率是次要结局测量指标。
在 49555 例 OHCA 中，分析了 4115 例（8.3%）观察到的公共场所 OHCA，其中 2500 例（60.8%）是可电击性的。旁观者电击应用于 18.8%的可电击性心脏骤停。与初始由紧急医疗服务进行电击的患者相比，被旁观者电击的患者更有可能存活至出院（66.5% 比 43.0%），并且更有可能出院时具有有利的功能结局（57.1% 比 32.7%）。在调整了已知结局预测因素后，旁观者电击相关的优势比为 2.62（95%置信区间，2.07-3.31），用于医院出院生存率，2.73（95%置信区间，2.17-3.44）用于出院时具有有利的功能结局。随着紧急医疗服务响应时间的延长，旁观者电击的益处呈递增趋势。
在可电击性观察到的公共场所 OHCA 中，紧急医疗服务到达前，旁观者使用自动体外除颤器与更好的生存率和功能结局相关。继续强调公共场所自动体外除颤器使用计划可能会进一步改善 OHCA 的结局。
