Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Scand J Trauma Resusc Emerg Med. 2019 Aug 23;27(1):79. doi: 10.1186/s13049-019-0658-7.
Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests.
We included paediatric patients aged 0-17 years with OHCAs before EMS arrival who were transported to medical institutions after resuscitation by bystanders or EMS personnel. We excluded paediatric OHCA patients for whom CPR was not performed, who had cardiac arrest after EMS arrival, whose EMS CPR duration were < 0 min or ≥120 min and who had cardiac arrest in healthcare facilities. Prehospital EMS CPR duration was defined as the time from CPR initiation by EMS personnel to the time of prehospital return of spontaneous circulation or to the time of hospital arrival. The primary outcome was 1-month survival with a favourable neurological outcome (cerebral performance category scale 1 or 2). Statistical analysis was performed with Mann-Whitney U tests for numerical variables and chi-squared test for categorical variables. Univariable and multivariable logistic regression analyses were applied to assess the association between prehospital EMS CPR duration and a favourable neurological outcome, and crude and adjusted odds ratios and their 95% confidence intervals were calculated.
The proportion of patients with a favourable neurological outcome was lower in residential locations than in public locations (2.3% [66/2865] vs 10.8% [113/1048]; P < .001). In both univariable and multivariable logistic regression analyses, the proportion of patients with a favourable neurological outcome decreased as prehospital EMS CPR duration increased, regardless of the location of arrests (P for trend <.001). However, some patients achieved a favourable neurological outcome after a prolonged prehospital EMS CPR duration (> 30 min) in both groups (1.4% [6/417] in residential locations and 0.6% [1/170] in public locations).
A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests.
关于急救医疗服务（EMS）进行的院前心肺复苏（CPR）持续时间与院外心脏骤停（OHCA）儿科患者结局之间的关联，知之甚少。我们调查了这些关联以及按发病地点确定的最佳院前 EMS CPR 持续时间。
我们纳入了在 EMS 到达前由旁观者或 EMS 人员复苏后被送往医疗机构的 0-17 岁 OHCAs 儿科患者。我们排除了未行 CPR 的儿科 OHCA 患者、在 EMS 到达后发生心脏骤停的患者、EMS CPR 持续时间<0 分钟或≥120 分钟的患者以及在医疗机构发生心脏骤停的患者。院前 EMS CPR 持续时间定义为 EMS 人员开始 CPR 至院前自主循环恢复或到达医院的时间。主要结局是 1 个月时生存且神经功能良好（脑功能分类量表 1 或 2）。采用 Mann-Whitney U 检验进行数值变量分析，采用卡方检验进行分类变量分析。应用单变量和多变量逻辑回归分析评估院前 EMS CPR 持续时间与神经功能良好结局之间的关联，并计算粗比数比及其 95%置信区间和调整比数比及其 95%置信区间。
在住宅地点，神经功能良好的患者比例低于公共场所（2.3%[66/2865]比 10.8%[113/1048]；P<0.001）。在单变量和多变量逻辑回归分析中，无论发病地点如何，神经功能良好的患者比例随着院前 EMS CPR 持续时间的增加而降低（趋势 P<0.001）。然而，在两组中，一些患者在较长的院前 EMS CPR 持续时间（>30 分钟）后仍获得了良好的神经功能结局（住宅地点为 1.4%[6/417]，公共场所为 0.6%[1/170]）。
较长的院前 EMS CPR 持续时间与神经功能良好结局的患者比例较低独立相关。院前 EMS CPR 持续时间与神经功能结局之间的关联因发病地点而异。
