院外环境下心肺复苏与胸部损伤之间的关联：一项回顾性观察研究。
The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study.
作者信息
Takayama Wataru, Koguchi Hazuki, Endo Akira, Otomo Yasuhiro
机构信息
1Trauma and Acute Critical Care Medical Center,Tokyo Medical and Dental University Hospital of Medicine,Tokyo,Japan.
2The Shock Trauma and Emergency Medical Center,Matsudo City Hospital,Matsudo City,Chiba Prefecture,Japan.
出版信息
Prehosp Disaster Med. 2018 Apr;33(2):171-175. doi: 10.1017/S1049023X18000201. Epub 2018 Mar 8.
OBJECTIVES
The aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA).
METHODS
This retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed.
RESULTS
A total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant.
CONCLUSIONS
Long duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times. Takayama W , Koguchi H , Endo A , Otomo Y . The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171-175.
目的
本研究旨在评估院外心脏骤停（OHCA）患者因胸部损伤在院外进行心肺复苏（CPR）的风险。
方法
本回顾性观察研究在日本一家急诊重症医疗中心开展。分析2013年4月至2016年8月间转送至该医院的非创伤性OHCA患者。结局定义为与CPR相关的胸部损伤，包括肋骨骨折、胸骨骨折和气胸。进行多因素逻辑回归分析以评估与CPR相关的胸部损伤的独立危险因素。还评估了增加胸部损伤风险的院外CPR持续时间阈值。
结果
共纳入472例患者，其中233例患者发生胸部损伤。多因素逻辑回归模型显示，胸部损伤的独立危险因素为年龄和院外CPR持续时间（年龄：调整后比值比[AOR]=1.06[95%置信区间（CI），1.04至1.07]；院外CPR持续时间：AOR=1.03[95%CI，1.01至1.05]）。院内CPR持续时间不是胸部损伤的独立危险因素。当院外CPR持续时间超过15分钟时，胸部损伤的可能性增加；然而，这种关联无统计学意义。
结论
院外CPR持续时间长是胸部损伤的独立危险因素，可能是由于难以维持足够的CPR质量。在需要长时间转运的情况下，预计将进一步开展研究以评估替代CPR设备的疗效。高山W、小口H、远藤A、大友Y。院外心肺复苏与胸部损伤的关联：一项回顾性观察研究。院前急救与灾难医学。2018；33（2）：171 - 175。
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