Stieglis Remy, Zijlstra Jolande A, Riedijk Frank, Smeekes Martin, van der Worp Wim E, Koster Rudolph W
Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
Resuscitation. 2020 May;150:170-177. doi: 10.1016/j.resuscitation.2020.01.031. Epub 2020 Feb 8.
For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated.
We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated.
In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km did not result in further decrease of time to first shock but >10 TM-responders/km resulted in more defibrillations <6 min.
With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km and >10 TM-responders/km.
对于居民区的院外心脏骤停（OHCA），实施了一种由调度员驱动的使用短信的警报系统（短信系统），该系统引导当地救援人员（短信响应者）前往OHCA患者处，并对自动体外除颤器（AED）或短信响应者的理想密度进行了调查。
我们纳入了2010年至2017年期间在居民区激活短信系统的OHCA病例。对于每个病例，计算了1000米范围内激活的AED和短信响应者的密度/平方公里。计算了拨打112电话与首次除颤之间的时间间隔。
总共813名患者（45%）初始心律可除颤。17%的患者由短信系统的AED进行了首次电击。随着AED密度增加，首次电击的中位时间从10:59分钟降至08:17分钟（p<0.001），电击时间<6分钟的比例从6%增加到12%（p=0.024）。短信响应者密度增加与首次电击的中位时间从10:59分钟降至08:20分钟相关（p<0.001），电击时间<6分钟的比例从6%增加到13%（p=0.005）。AED和短信响应者密度增加分别导致救护车首次除颤下降了19%（p=0.016）和22%（p=0.001）。第一响应者的AED除颤没有显著变化。AED密度>2台/平方公里并未导致首次电击时间进一步缩短，但短信响应者密度>10名/平方公里导致更多电击时间<6分钟。
随着短信系统内AED和短信响应者密度增加，居民区的除颤时间缩短。AED和短信响应者仅与救护车竞争，而非与第一响应者竞争。为实现最早除颤，推荐的AED和短信响应者密度分别为2台/平方公里和>10名/平方公里。
