Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Division of Anaesthesiology for Cardiovascular and Thoracic Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Sci Rep. 2021 Mar 4;11(1):5120. doi: 10.1038/s41598-021-84718-4.
This study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response system. Data on patients attended for cardiac arrest between January 1st, 2010 and December 31st, 2018 except babies at birth were included. Logistic regression analysis with start of CPR by physicians as the dependent variable and possible associated factors as independent variables adjusted for anonymised physician identifiers was conducted. 1525 patient data sets were analysed. Obvious signs of death were present in 278 cases; in the remaining 1247, resuscitation was attempted in 920 (74%) and were withheld in 327 (26%). Factors significantly associated with higher likelihood of CPR by physicians (OR 95% CI) were resuscitation efforts by EMS before physician arrival (60.45, 19.89-184.29), first monitored heart rhythm (3.07, 1.21-7.79 for PEA; 29.25, 1.93-442. 51 for VF / pVT compared to asystole); advanced patient age (modelled using cubic splines), physician response time (0.92, 0.87-0.97 per minute) and malignancy (0.22, 0.05-0.92) were significantly associated with lower odds of CPR. We thus conclude that prehospital physicians make decisions to start or withhold resuscitation routinely and base those mostly on situational information and immediately available patient information known to impact outcomes.
本研究旨在确定与院前医师决定开始（如果正在进行）或停止（如果正在进行）心肺复苏（CPR）的相关因素，以治疗院外心搏骤停（OHCA）患者。我们使用院前医师反应系统的匿名数据进行了回顾性研究。纳入了 2010 年 1 月 1 日至 2018 年 12 月 31 日期间除新生儿外因心脏骤停接受治疗的患者数据。将以医师开始 CPR 为因变量，可能的相关因素为自变量，进行逻辑回归分析，并调整医师的匿名标识符。共分析了 1525 例患者数据集。278 例患者有明显死亡迹象；在其余 1247 例患者中，920 例（74%）尝试复苏，327 例（26%）未复苏。与医师更有可能进行 CPR 的因素（OR95%CI）显著相关的因素包括医师到达前 EMS 的复苏努力（60.45，19.89-184.29）、首次监测的心律（PEA 为 3.07，1.21-7.79；VF/pVT 为 29.25，1.93-442.51 与心搏骤停相比）、患者年龄较大（采用三次样条模型）、医师反应时间（每分钟 0.92，0.87-0.97）和恶性肿瘤（0.22，0.05-0.92）。因此，我们得出结论，院前医师通常会根据情况信息和对预后有影响的患者即时信息来决定开始或停止复苏。
