Kurosaki Hisanori, Takada Kohei, Yamashita Akira, Tanaka Yoshio, Inaba Hideo
Department of Circulatory Emergency and Resuscitation Science Kanazawa University Graduate School of Medicine Kanazawa Japan.
Department of Cardiology Noto General Hospital Nanao Japan.
Acute Med Surg. 2020 Nov 28;7(1):e607. doi: 10.1002/ams2.607. eCollection 2020 Jan-Dec.
Using the data from the All-Japan Utstein Registry, this study evaluates the neurologically favourable patient outcomes and associated factors of out-of-hospital cardiac arrest (OHCA) with Japanese schoolchildren as witnesses.
We analysed 1,068 school-age children (6-18 years old) who underwent OHCA from 2011 to 2016. Among the 1,068 cases, 179 were witnessed by schoolchildren and 889 were witnessed by other bystanders. Propensity score-matched and logistic regression analyses were used to evaluate the outcomes and associated factors.
The crude neurologically favourable outcome in the schoolchildren-witnessed group was considerably higher than that in the other-bystander-witnessed group (19.6% versus 12.3%; < 0.010). However, the difference was not significant in the propensity score-matched analysis (19.6% versus 21.8%; = 0.602). The multivariable logistic regression analyses of school-age OHCA with schoolchildren as witnesses demonstrated that bystander cardiopulmonary resuscitation (CPR) provision (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.44-11.75), shockable initial rhythm (OR 3.39, 95% CI 1.43-8.04), and defibrillation (OR 4.58, 95% CI 1.65-12.71) provided by any bystander were positively associated with favourable outcomes. By contrast, dispatcher-assisted CPR provision (OR 0.28, 95% CI 0.11-0.70), exogenous cause (OR 0.16, 95% CI 0.03-0.86), adrenaline administration (0.25; 95% CI 0.07-0.92), and prolonged response time (OR 0.86; 95% CI 0.75-0.98) were negatively associated with favourable outcomes.
Patient outcomes did not differ significantly between schoolchildren- and other-bystander-witnessed cases of school-age OHCA. Although schoolchildren as witnesses might not be inferior to other bystanders in school-age OHCA, further studies are needed to examine the effect of bystander CPR by schoolchildren and basic life support education in schools.
本研究利用全日本Utstein登记处的数据，评估以日本学童为目击者的院外心脏骤停（OHCA）患者的神经功能良好结局及相关因素。
我们分析了2011年至2016年期间发生OHCA的1068名学龄儿童（6 - 18岁）。在这1068例病例中，179例由学童目击，889例由其他旁观者目击。采用倾向评分匹配和逻辑回归分析来评估结局及相关因素。
学童目击组的粗略神经功能良好结局显著高于其他旁观者目击组（19.6%对12.3%；<0.010）。然而，在倾向评分匹配分析中差异不显著（19.6%对21.8%；=0.602）。以学童为目击者的学龄OHCA的多变量逻辑回归分析表明，任何旁观者进行的旁观者心肺复苏（CPR）（比值比[OR]4.12，95%置信区间[CI]1.44 - 11.75）、可电击的初始心律（OR 3.39，95%CI 1.43 - 8.04）和除颤（OR 4.58，95%CI 1.65 - 12.71）与良好结局呈正相关。相比之下，调度员辅助的CPR（OR 0.28，95%CI 0.11 - 0.70）、外部原因（OR 0.16，95%CI 0.03 - （此处原文有误，应为0.86））、肾上腺素给药（0.25；95%CI 0.07 - 0.92）和较长的反应时间（OR 0.86；95%CI 0.75 - 0.98）与良好结局呈负相关。
学龄OHCA中学童目击和其他旁观者目击的病例之间患者结局无显著差异。尽管在学龄OHCA中学童作为目击者可能并不逊于其他旁观者，但仍需进一步研究以考察学童进行旁观者CPR的效果及学校的基本生命支持教育情况。 （注：原文中“exogenous cause (OR 0.16, 95% CI 0.03 - 0.86)”疑似有误，根据上下文推测可能是“exogenous cause (OR 0.16, 95% CI 0.03 - 0.86)”，翻译时已按此修正。）
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