National Fire Agency, Sejong, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.
Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
Am J Emerg Med. 2021 Sep;47:17-23. doi: 10.1016/j.ajem.2021.03.021. Epub 2021 Mar 15.
We investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type.
A population-based observational study was conducted for nursing home OHCAs during 2013-2018. The exposure was the bystander type: medical staff, non-medical staff, or family. The primary outcome was bystander CPR provision rate; the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and survival to discharge. Multivariable logistic regression analysis which corrected for various demographic and clinical characteristics evaluated bystander type impact on study outcomes. Bystander CPR rate trend was investigated by bystander type.
Of 8281 eligible OHCA patients, 26.0%, 70.8%, and 3.2% cases were detected by medical staff, non-medical staff, and family, respectively. Provision rate of bystander CPR was 69.9% and rate of bystander defibrillation was 0.4% in total. Bystander CPR was provided by medical staff, non-medical staff, and families in 74.8%, 68.9%, and 52.1% respectively. Total survival rate was 2.2%, out of which, 3.3% was for medical staff, 3.2% for non-medical staff, and 0.6% for family. Compared to the results of detection by medical staff, the adjusted odds ratios (95% CIs) for provision of bystander CPR were 0.56 (0.49-0.63) for detection by non-medical staff and 0.33 (0.25-0.44) for detection by family. The bystander CPR rates of all three groups increased over time, and among them, the medical staff group increased the most. For prehospital ROSC and survival to discharge, no significant differences were observed according to bystander type.
Although OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.
我们通过旁观者类型调查了养老院院外心脏骤停（OHCA）患者旁观者心肺复苏（CPR）提供率和生存结局。
这是一项基于人群的观察性研究，对 2013 年至 2018 年期间养老院的 OHCA 进行了研究。暴露因素为旁观者类型：医务人员、非医务人员或家庭成员。主要结局是旁观者 CPR 提供率；次要结局是院前自主循环恢复（ROSC）和出院存活。多变量逻辑回归分析校正了各种人口统计学和临床特征，评估了旁观者类型对研究结局的影响。通过旁观者类型调查了旁观者 CPR 率趋势。
在 8281 例符合条件的 OHCA 患者中，分别有 26.0%、70.8%和 3.2%的患者由医务人员、非医务人员和家庭成员发现。总旁观者 CPR 提供率为 69.9%，旁观者除颤率为 0.4%。医务人员、非医务人员和家庭成员分别提供了 74.8%、68.9%和 52.1%的旁观者 CPR。总存活率为 2.2%，其中医务人员为 3.3%，非医务人员为 3.2%，家庭成员为 0.6%。与医务人员发现的结果相比，非医务人员发现的旁观者 CPR 提供的调整优势比（95%CI）为 0.56（0.49-0.63），家庭成员发现的调整优势比为 0.33（0.25-0.44）。所有三组的旁观者 CPR 率均随时间增加，其中医务人员组增加最多。对于院前 ROSC 和出院存活，旁观者类型没有明显差异。
尽管非医务人员更常发现 OHCA，但他们提供旁观者 CPR 的频率低于医务人员。为了提高养老院 OHCA 的生存结局，需要采取捆绑干预措施，包括增加自动体外除颤器的使用和扩大养老院非医务人员的 CPR 培训。
