Hessulf Fredrik, Herlitz Johan, Rawshani Araz, Aune Solveig, Israelsson Johan, Södersved-Källestedt Marie-Louise, Nordberg Per, Lundgren Peter, Engdahl Johan
Department of Anaesthesiology and Intensive Care Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden; Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; PreHospen - Centre of Prehospital Research; Academy of Caring Science, Welfare and Work Life, University of Borås, SE-501 90 Borås, Sweden.
Resuscitation. 2020 Oct;155:13-21. doi: 10.1016/j.resuscitation.2020.07.009. Epub 2020 Jul 21.
Most resuscitation guidelines have recommendations regarding maximum delay times from collapse to calling for the rescue team and initiation of treatment following cardiac arrest. The aim of the study was to investigate the association between adherence to guidelines for cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest (IHCA) and survival with a focus on delay to treatment.
We used the Swedish Registry for CPR to study 3212 patients with a shockable rhythm and 9113 patients with non-shockable rhythm from January 1, 2008 to December 31, 2017. Adult patients older than or equal to 18 years with a witnessed IHCA where resuscitation was initiated were included. We assessed trends in adherence to guidelines and their associations with 30-day survival and neurological function. Adherence to guidelines was defined as follows: time from collapse to calling for the rescue team and CPR within 1 min for non-shockable rhythms. For shockable rhythms, adherence was defined as the time from collapse to calling for the rescue team and CPR within 1 min and defibrillation within 3 min.
In patients with a shockable rhythm, the 30-day survival for those treated according to guidelines was 66.1%, as compared to 46.5% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.84 (95% CI 1.52-2.22). Among patients with a non-shockable rhythm the 30-day survival for those treated according to guidelines was 22.8%, as compared to 16.0% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.43 (95% CI 1.24-1.65). Neurological function (cerebral performance category 1-2) among survivors was better among patients treated in accordance with guidelines for both shockable (95.7% vs 91.1%, <0.001) and non-shockable rhythms (91.0% vs 85.5%, p < 0.008). Adherence to the Swedish guidelines for CPR increased slightly 2008-2017.
Adherence to guidelines was associated with increased probability of survival and improved neurological function in patients with a shockable and non-shockable rhythm, respectively. Increased adherence to guidelines could increase cardiac arrest survival.
大多数复苏指南都对从心脏骤停倒地到呼叫救援团队以及开始治疗的最长延迟时间提出了建议。本研究的目的是调查院内心脏骤停（IHCA）后心肺复苏（CPR）指南的遵循情况与生存之间的关联，重点关注治疗延迟情况。
我们使用瑞典心肺复苏登记处的数据，研究了2008年1月1日至2017年12月31日期间3212例可电击心律患者和9113例不可电击心律患者。纳入年龄大于或等于18岁、有目击者的院内心脏骤停且已开始进行复苏的成年患者。我们评估了指南遵循情况的趋势及其与30天生存率和神经功能的关联。指南遵循情况定义如下：对于不可电击心律，从倒地到呼叫救援团队以及开始心肺复苏的时间在1分钟内。对于可电击心律，遵循情况定义为从倒地到呼叫救援团队以及开始心肺复苏的时间在1分钟内，且除颤时间在3分钟内。
在可电击心律患者中，遵循指南治疗的患者30天生存率为66.1%，而在一个或多个参数上未遵循指南治疗的患者中这一比例为46.5%，校正比值比为1.84（95%可信区间1.52 - 2.22）。在不可电击心律患者中，遵循指南治疗的患者30天生存率为22.8%，而在一个或多个参数上未遵循指南治疗的患者中这一比例为16.0%，校正比值比为1.43（95%可信区间1.24 - 1.65）。对于可电击心律和不可电击心律的患者，遵循指南治疗的幸存者神经功能（脑功能分级1 - 2级）均更好（可电击心律患者中分别为95.7%对91.1%，<0.001；不可电击心律患者中分别为91.0%对85.5%，p < 0.008）。2008 - 2017年期间，瑞典心肺复苏指南的遵循情况略有增加。
遵循指南分别与可电击心律和不可电击心律患者生存率提高及神经功能改善相关。增加对指南的遵循情况可能会提高心脏骤停患者的生存率。
