Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka 812-8582, Japan.
Int J Cardiol. 2018 Aug 15;265:240-245. doi: 10.1016/j.ijcard.2018.04.067. Epub 2018 Apr 19.
Bystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA.
This is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18-100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event.
During the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78-0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65-1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43-0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased.
Survival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit.
旁观者心肺复苏（CPR）对院外心脏骤停（OHCA）患者的生存至关重要。然而，尚不清楚是否有旁观者 CPR 与调度员协助的旁观者 CPR （无调度员协助的旁观者 CPR）更有效，或者为什么更有效。因此，我们评估了调度员协助的旁观者 CPR（与无调度员协助的旁观者 CPR 相比）与 OHCA 患者生存之间的关系。
这是一项回顾性、非随机、观察性研究，使用了 2005 年至 2014 年日本所有 OHCA 的全国登记数据。我们进行了倾向评分分析。OHCA 的心脏起源年龄在 18-100 岁，在日本接受旁观者胸部按压。主要转归指标为旁观者救援呼吸、到达医院前自主循环恢复（ROSC）以及事件后 1 个月的生存和脑功能分类（CPC）1 或 2。
在研究期间，发生了 1176351 例 OHCA，87400 例符合纳入标准。在倾向评分匹配的患者中，在完全调整模型中，调度员协助的旁观者 CPR 与转归指标呈负相关[复苏的优势比（OR）（95%可信区间）=0.87（0.78-0.97），P<0.05；1 个月生存率的 OR（95%可信区间）=0.81（0.65-1.00），P<0.05；CPC 1 或 2 的 OR（95%可信区间）=0.64（0.43-0.93），P<0.05]。随着紧急医疗服务反应时间的增加，调度员协助的旁观者 CPR 的生存优势呈下降趋势。
调度员协助的旁观者 CPR 的生存获益低于无调度员协助的旁观者 CPR。低质量被假设是降低获益的原因。
