Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Kangwon National University College of Medicine, Chuncheon, Gangwon-do, Republic of Korea.
Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Resuscitation. 2018 Sep;130:49-56. doi: 10.1016/j.resuscitation.2018.06.029. Epub 2018 Jun 28.
We investigated the effect of bystander cardiopulmonary resuscitation (BCPR) with dispatcher assistance (DA) on neurological outcomes based on the response time interval (RTI) of the pre-hospital emergency medical service (EMS) among paediatric patients with out-of-hospital cardiac arrest (OHCA).
This retrospective registry study was conducted on paediatric patients (<19 years old) with OHCA who were assessed by EMS providers between 2012 and 2016. The primary outcome was good neurological recovery based on BCPR with or without DA and the EMS RTI. Differential effects of BCPR with DA based on the EMS RTI were analysed by multivariable logistic regression analysis with interaction terms.
Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs) for good neurological recovery were 2.22 (1.27-3.88) for BCPR with DA and 1.51 (0.77-2.97) for BCPR without DA compared to no BCPR. The faster EMS RTI group (<5 min) had better neurological recovery than the later EMS RTI group (≥5 min) (AOR: 1.87 [1.04-3.29]). The AORs for good neurological recovery following BCPR with DA based on the EMS RTI were 2.52 (0.91-6.97) in the faster EMS RTI group and 2.17 (1.13-4.19) in the later EMS RTI group compared to the no BCPR group.
BCPR with DA and a faster EMS RTI were significantly associated with good neurological recovery in paediatric patients with OHCA. When the EMS RTI was delayed, the association of BCPR with DA with good neurological recovery was preserved in paediatric patients with OHCA.
本研究旨在探讨在儿童院外心脏骤停（OHCA）患者中，基于院前急救医疗服务（EMS）反应时间间隔（RTI），有或无调度员协助（DA）的旁观者心肺复苏（BCPR）对神经功能结局的影响。
本回顾性注册研究纳入了 2012 年至 2016 年期间由 EMS 提供者评估的儿童 OHCA 患者（<19 岁）。主要结局为 BCPR 联合或不联合 DA 以及 EMS RTI 下的良好神经功能恢复。通过多变量逻辑回归分析和交互项分析，探讨了 BCPR 联合 DA 基于 EMS RTI 的差异效应。
与无 BCPR 相比，BCPR 联合 DA 的调整后优势比（AOR）及相应 95%置信区间（95%CI）为良好神经功能恢复的 2.22（1.27-3.88），BCPR 无 DA 的 AOR 为 1.51（0.77-2.97）。EMS RTI 较短（<5 分钟）组的神经功能恢复优于 EMS RTI 较长（≥5 分钟）组（AOR：1.87 [1.04-3.29]）。基于 EMS RTI，BCPR 联合 DA 后良好神经功能恢复的 AOR 分别为 EMS RTI 较短组 2.52（0.91-6.97）和 EMS RTI 较长组 2.17（1.13-4.19），与无 BCPR 组相比。
BCPR 联合 DA 和 EMS RTI 较快与儿童 OHCA 患者的良好神经功能恢复显著相关。当 EMS RTI 延迟时，BCPR 联合 DA 与良好神经功能恢复的相关性在儿童 OHCA 患者中得以保留。
