Naito Hiromichi, Yumoto Tetsuya, Yorifuji Takashi, Tahara Yoshio, Yonemoto Naohiro, Nonogi Hiroshi, Nagao Ken, Ikeda Takanori, Sato Naoki, Tsutsui Hiroyuki
Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan.
Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan.
Resuscitation. 2020 Aug;153:251-257. doi: 10.1016/j.resuscitation.2020.05.007. Epub 2020 May 15.
Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes.
In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs.
Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes.
Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.
紧急救生技术人员（ELSTs）是经过专门培训的院前医疗提供者，被认为比基础急救医疗技术人员（BEMTs）能提供更好的护理。ELSTs 获得认证可执行诸如高级气道管理或肾上腺素给药等技术，并且被认为拥有更多知识；然而，在院外心脏骤停（OHCA）方面，ELSTs 相对于 BEMTs 的有效性仍不明确。我们调查了 ELSTs 的存在是否能改善 OHCA 患者的预后。
在一项对 2011 年至 2015 年在日本接受治疗的成年 OHCA 患者的回顾性研究中，我们比较了两组 OHCA 患者：至少有一名 ELST 运送的患者和仅由 BEMTs 运送的患者。主要结局指标是一个月时良好的神经功能结局，定义为脑功能分类≤2。使用多变量逻辑回归模型计算比值比（ORs）及其置信区间（CIs）以评估 ELSTs 的效果。
纳入了 552,337 例 OHCA 患者，其中 ELST 组有 538,222 例患者，BEMT 组有 14,115 例患者。与 BEMT 组相比，ELST 组具有良好神经功能结局的几率显著更高（2.5%对 2.1%，调整后的 OR 为 1.39，95%CI 为 1.17 - 1.66）、一个月生存率（4.9%对 4.1%，调整后的 OR 为 1.37，95%CI 为 1.22 - 1.54）以及自主循环恢复率（8.1%对 5.1%，调整后的 OR 为 1.90，95%CI 为 1.72 - 2.11）。然而，ELSTs 有限的操作范围（肾上腺素给药或高级气道管理）并未促进良好的神经功能结局。
与 BEMT 组相比，ELST 组运送的患者在 OHCA 中具有更好的神经功能结局。
