Prehosp Emerg Care. 2019 May-Jun;23(3):420-429. doi: 10.1080/10903127.2018.1511017. Epub 2018 Sep 10.
Shockable rythms are common among victims of witnessed public out-of-hospital cardiac arrest (OHCA), but bystander defibrillation with a public automated external defibrillator (PAED) is rare. Instructions from the emergency medical dispatcher and mobile applications were developed to expedite the localization of PAEDs, but their effectiveness has not been compared.
Participants were enrolled in a three-armed randomized simulation where they witnessed a simulated OHCA on a university campus, were instructed to locate a PAED and provide defibrillation. Participants were stratified and randomized to: (1) no assistance in finding the PAED, (2) assistance from a geolocalization mobile application (AED-Quebec), or (3) verbal assistance. Data collectors tracked each participant's time elapsed and distance traveled to shock.
Of the 52 volunteers participating in the study (46% male, mean age 37), 17 were randomized to the no assistance group, 18 to the mobile application group and 17 to the verbal group. Median (IQR) time to shock was, respectively, 10:00 min (7:49-10:00), 9:44 (6:30-10:00), and 5:23 (4:11-9:08), with statistically significant differences between the verbal group and the other groups (p ≤ 0.01). The success rate for defibrillation in <10 minutes was 35%, 56% and 76%. Multivariate regression of all participants pooled showed that knowledge of campus geography was the strongest predictor of shock in <10 minutes (aOR =14.3, 95% CI 1.85-99.9). Among participants without prior geographical knowledge, verbal assistance provided a trend towards decreased time to shock, but the differences over no assistance (7:28 vs. 10:00, p = 0.10) and over the mobile app (7:28 vs. 10:00, p = 0.11) were not statistically significant.
In a simulated environment, verbally providing OHCA bystanders with the nearest PAED's location appeared to be effective in reducing the time to defibrillation in comparison to no assistance and to an AED geolocalizing mobile app, but further research is required to confirm this hypothesis, ascertain the external validity of these results, and evaluate the real-life implications of these strategies.
在有目击者的院外心脏骤停（OHCA）患者中，可电击心律较为常见，但旁观者使用公共自动体外除颤器（PAED）除颤的情况却很少见。急救医疗调度员和移动应用程序的使用是为了加快 PAED 的定位，但尚未比较其效果。
参与者参加了一项三臂随机模拟研究，在该研究中，他们在大学校园目睹了一次模拟 OHCA，并被指示寻找 PAED 并进行除颤。参与者按分层和随机分组：（1）在寻找 PAED 时不提供帮助，（2）使用地理定位移动应用程序（AED-Quebec）提供帮助，或（3）提供口头帮助。数据收集者跟踪每个参与者到达电击的时间和距离。
在参与研究的 52 名志愿者（46%为男性，平均年龄 37 岁）中，17 名随机分配到无帮助组，18 名随机分配到移动应用程序组，17 名随机分配到口头组。电击时间的中位数（IQR）分别为 10:00 分钟（7:49-10:00）、9:44 分钟（6:30-10:00）和 5:23 分钟（4:11-9:08），口头组与其他组之间存在统计学显著差异（p≤0.01）。<10 分钟内除颤成功率分别为 35%、56%和 76%。对所有参与者进行的多变量回归显示，对校园地理的了解是<10 分钟内电击的最强预测因素（优势比=14.3，95%置信区间 1.85-99.9）。在没有先前地理知识的参与者中，口头协助有减少电击时间的趋势，但与无协助（7:28 分钟对 10:00 分钟，p=0.10）和移动应用程序（7:28 分钟对 10:00 分钟，p=0.11）相比，差异无统计学意义。
在模拟环境中，与无帮助和 AED 地理定位移动应用程序相比，口头向 OHCA 旁观者提供最近的 PAED 位置似乎可以有效缩短除颤时间，但需要进一步研究来证实这一假设，确定这些结果的外部有效性，并评估这些策略在现实生活中的意义。
