Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan.
Lancet. 2019 Dec 21;394(10216):2255-2262. doi: 10.1016/S0140-6736(19)32488-2. Epub 2019 Dec 17.
More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients.
This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918.
We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001).
Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community.
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在到达急救医疗服务（EMS）人员之前，有院外心脏骤停（OHCA）和可电击性心律的患者中，超过 80%的公众可获取的除颤尝试未能导致自主循环的持续恢复。此类患者的神经和生存结果尚未得到评估。我们旨在评估此类患者的神经状态和生存结果。
这是对 2005 年 1 月 1 日至 2015 年 12 月 31 日期间在日本发生的 1299784 例 OHCA 事件的前瞻性、全国性、基于人群的队列研究的回顾性分析。主要结局是 OHCA 后 30 天的有利神经结局（脑功能分类为 1 或 2），次要结局是 OHCA 后 30 天的生存。本研究在大学医院医疗信息网络临床试验注册中心（UMIN000009918）注册。
我们确定了 28019 例有旁观者目击的 OHCA 和可电击性心律的患者，他们接受了旁观者的 CPR。其中，2242 例（8.0%）患者在 CPR 加公众可获取的除颤后未能恢复自主循环，25087 例（89.5%）患者在 EMS 到达前未能单独通过 CPR 恢复自主循环。接受公众可获取的除颤的患者的有利神经结局比例明显高于未接受除颤的患者（845[37.7%]比 5676[22.6%]；经过倾向评分匹配后的调整优势比[OR]，1.45[95%CI 1.24-1.69]，p<0.0001）。接受公众可获取的除颤的患者在 OHCA 后 30 天的存活率也明显高于未接受除颤的患者（987[44.0%]比 7976[31.8%]；经过倾向评分匹配后的调整 OR，1.31[95%CI 1.13-1.52]，p<0.0001）。
我们的研究结果支持公众可获取的除颤以及在社区中提供更多的和可获得的自动体外除颤器的益处。
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