院外心脏骤停除颤的急救人员、第一反应者和旁观者的生存趋势。
Trends in survival from out-of-hospital cardiac arrests defibrillated by paramedics, first responders and bystanders.
机构信息
Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia.
Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
出版信息
Resuscitation. 2019 Oct;143:85-91. doi: 10.1016/j.resuscitation.2019.08.018. Epub 2019 Aug 17.
BACKGROUND
Although survival from out-of-hospital cardiac arrest (OHCA) is increasing, little is known about the long-term trends in survival for patients defibrillated by first responders and bystanders.
METHODS
Between 2000 and 2017, we included adult non-traumatic OHCA with an initial shockable rhythm from the Victorian Ambulance Cardiac Arrest Registry. Adjusted logistic regression analyses were used to assess trends in survival to hospital discharge according to whether the patient was initially shocked by paramedics, first responders or bystanders.
RESULTS
Of the 10,451 initial shockable arrests, 796 (7.6%) and 526 (5.0%) were initially shocked by first responders and bystanders, respectively. Between 2000-02 and 2015-17, the proportion of cases initially shocked by first responders and bystanders increased from 3.8% to 8.2% and from 2.0% to 11.2%, respectively. Over the same period, survival to hospital discharge increased from 11.6% to 28.8% for cases initially shocked by paramedics, from 10.5% to 37.8% for cases initially shocked by first responders, and from 6.7% to 55.5% for cases initially shocked by bystanders (p trend <0.001 for all). In the adjusted analyses, patients initially shocked by first responders (AOR 1.40, 95% CI: 1.18, 1.67; p < 0.001) and bystanders (AOR 2.11, 95% CI: 1.72, 2.59; p < 0.001) were more likely to survive to hospital discharge than those initially shocked by paramedics. The odds of survival increased year-on-year by 8.1% for patients shocked by paramedics (p < 0.001), 6.1% for patients shocked by first responders (p = 0.004), and 11.8% for patients shocked by bystanders (p < 0.001).
CONCLUSION
OHCA patients initially defibrillated by bystanders yielded the largest improvements in survival over time.
背景
尽管院外心脏骤停（OHCA）患者的存活率在提高，但对于最初由急救人员和旁观者除颤的患者，其长期存活率趋势却鲜为人知。
方法
本研究纳入了 2000 年至 2017 年间维多利亚救护车心脏骤停注册中心的成人非创伤性 OHCA 患者，这些患者初始节律为可除颤节律。采用调整后的逻辑回归分析，根据患者是否最初由护理人员、急救人员或旁观者进行除颤，评估出院时存活的趋势。
结果
在 10451 例初始可除颤的骤停事件中，分别有 796 例（7.6%）和 526 例（5.0%）最初由急救人员和旁观者进行除颤。在 2000-02 年至 2015-17 年期间，最初由急救人员和旁观者进行除颤的病例比例分别从 3.8%增加到 8.2%和从 2.0%增加到 11.2%。在此期间，由护理人员最初除颤的病例出院存活率从 11.6%增加到 28.8%，由急救人员最初除颤的病例从 10.5%增加到 37.8%，由旁观者最初除颤的病例从 6.7%增加到 55.5%（所有趋势 p 值均<0.001）。在调整后的分析中，最初由急救人员（AOR 1.40，95%CI：1.18，1.67；p<0.001）和旁观者（AOR 2.11，95%CI：1.72，2.59；p<0.001）除颤的患者更有可能存活至出院。由护理人员除颤的患者存活率逐年增加 8.1%（p<0.001），由急救人员除颤的患者存活率增加 6.1%（p=0.004），由旁观者除颤的患者存活率增加 11.8%（p<0.001）。
结论
OHCA 患者最初由旁观者除颤，其存活率随时间的推移有最大的改善。
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