Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, German Armed Forces Hospital Ulm; Department of Anesthesiology and Intensive Care Medicine, Alb-Fils Hospitals, Göppingen.
Dtsch Arztebl Int. 2020 Dec 21;117(51-52):871-877. doi: 10.3238/arztebl.2020.0871.
Resuscitation by laypersons is important in bridging the time between the occurrence of an out-of-hospital cardiac arrest (OHCA) and the arrival of emergency rescue service personnel. Depending on the reason for the cardiac arrest, however, the effectiveness of chest compressions is uncertain. The aim of this study was to explore the impact of lay resuscitation on survival following OHCA of different causes.
The data set for analysis comprised all cases of cardiac arrest before the arrival of emergency rescue service personnel that were fully documented in the German Resuscitation Registry in the period 2007-2019. The following endpoints related to resuscitation by bystanders were evaluated-separately for each cause-descriptively and by means of multivariate logistic regression analysis: return of spontaneous circulation (ROSC), 30 days' survival/discharged alive from the hospital, and good neurological function at discharge.
Altogether, 40 604 cases of cardiac arrest were included. Resuscitation by laypersons was carried out in 35.1% of these cases. The rate of ROSC was statistically significantly higher after lay resuscitation for OHCA caused by cardiac events, drowning, intoxication, or central nervous system disorders (overall 48.1% versus 41.0%). For all causes-with the exception of trauma/bleeding to death and sepsis- the endpoint 30 days' survival/discharged alive was better with lay resuscitation (overall 17.0% versus 9.5%). In multivariate regression analysis, lay resuscitation was associated with improvement of the endpoint 30 days' survival/discharged alive only for OHCA caused by cardiac events (odds ratio [OR] 1.16) or intoxication (OR 1.81). For all other causes-except hypoxia-lay resuscitation tended to yield better results. Neurological function at discharge was also significantly better (overall 11.5% versus 6.1%) after lay resuscitation for OHCA of all causes except trauma/ bleeding to death, hypoxia, and sepsis.
Resuscitation by laypersons is associated with an improved result regarding the endpoint 30 days' survival/discharged alive in cases of OHCA caused by cardiac events and intoxication. These two groups account for 81% of the resuscitation patients in the study. Because there was also a tendency towards higher survival rates following OHCA of other causes (except hypoxia), laypersons should continue to be encouraged to attempt resuscitation in all cases of OHCA, whatever the cause.
在院外心脏骤停（OHCA）发生和紧急救援人员到达之间的这段时间，由非专业人员进行复苏非常重要。然而，根据心脏骤停的原因，胸外按压的效果并不确定。本研究的目的是探讨不同原因的 OHCA 中由非专业人员进行复苏对生存的影响。
本分析数据集包括 2007 年至 2019 年期间德国复苏登记处中所有在紧急救援人员到达之前有完整记录的心脏骤停病例。分别评估每个原因的旁观者复苏相关的以下终点-描述性和多变量逻辑回归分析：自主循环恢复（ROSC）、30 天生存/出院存活率和出院时良好的神经功能。
共纳入 40604 例心脏骤停病例。在这些病例中，有 35.1%由非专业人员进行复苏。对于由心脏事件、溺水、中毒或中枢神经系统疾病引起的 OHCA，非专业人员复苏后的 ROSC 率明显更高（总体为 48.1%，而 41.0%）。对于所有原因-除创伤/出血死亡和脓毒症外-非专业人员复苏的 30 天生存/出院存活率更好（总体为 17.0%，而 9.5%）。在多变量回归分析中，非专业人员复苏仅与心脏事件（优势比[OR]1.16）或中毒（OR 1.81）引起的 OHCA 的 30 天生存/出院存活率改善相关。对于所有其他原因-除缺氧外-非专业人员复苏的结果倾向于更好。对于所有原因引起的 OHCA，非专业人员复苏后的出院时神经功能也明显更好（总体为 11.5%，而 6.1%），除创伤/出血死亡、缺氧和脓毒症外。
对于由心脏事件和中毒引起的 OHCA，非专业人员复苏与 30 天生存/出院存活率终点改善相关。这两组占研究中复苏患者的 81%。由于其他原因（除缺氧外）引起的 OHCA 后生存率也有升高的趋势，因此应继续鼓励非专业人员在所有 OHCA 情况下尝试复苏，无论原因如何。
