通过调度员辅助心肺复苏提高日本可电击心律发生率和生存率。
Increasing the shockable rhythm and survival rate by dispatcher-assisted cardiopulmonary resuscitation in Japan.
作者信息
Kayanuma Minoru, Sagisaka Ryo, Tanaka Hideharu, Tanaka Shota
机构信息
Fujigoko Fire Department, Yamanashi, Japan.
Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
出版信息
Resusc Plus. 2021 Apr 24;6:100122. doi: 10.1016/j.resplu.2021.100122. eCollection 2021 Jun.
PURPOSE
This study aimed to examine the effectiveness of cardiopulmonary resuscitation (CPR) directions by dispatchers. We analysed the relationship of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) with favourable cerebral function, shockable rhythm rate, and emergency medical service (EMS) arrival time.
METHODS
This nationwide study was based on CPR statistical data of out-of-hospital cardiac arrest (OHCA) patients (n = 629,471) from 1 January 2011 to 31 December 2015, and included 107,669 patients with bystander-witnessed cardiogenic cardiac arrest.The primary outcome was good brain function prognosis after 1 month, while the secondary outcome was the rate of shockable rhythm on ECG at the time of EMS arrival.EMS arrival time at the site was stratified into 7 min, 8-10 min, and 11-20 min using tertiles. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were estimated using multivariate logistic regression analysis to assess the association between DA-BCPR and outcomes in each tertile.
RESULTS
There were 37,269 (35%), 18,109 (17%), and 52,291 (49%) patients in the DA-BCPR, Only-BCPR, and no-BCPR groups, respectively. Compared to No-BCPR, DA-BCPR was associated with favourable neurological outcomes regardless of the time from 119 call to EMS contact (AOR, 1.56, 2.01, 1.82; 95% CI, 1.43-1.71, 1.80-2.24, 1.52-2.19; ≤7 min, 8-10 min, and 11-20 min, respectively). DA-BCPR showed association with the shockable rhythm rate upon EMS arrival regardless of the time 119 call to EMS contact (AOR, 1.30, 1.60, 1.90; 95% CI, 1.23-1.38, 1.51-1.70, 1.75-2.06; ≤7 min, 8-10 min, and 11-20 min, respectively).
CONCLUSION
Providing dispatcher assistance with CPR to 119 callers improves the long-term outcome regardless of the patient's age and EMS response time. Thus, encouraging dispatchers to promote BCPR is important for increasing the shockable rhythm rate and improving the brain function prognosis.
目的
本研究旨在探讨调度员进行心肺复苏指导的有效性。我们分析了调度员辅助旁观者心肺复苏（DA-BCPR）与良好脑功能、可电击心律发生率及紧急医疗服务（EMS）到达时间之间的关系。
方法
这项全国性研究基于2011年1月1日至2015年12月31日期间院外心脏骤停（OHCA）患者（n = 629,471）的心肺复苏统计数据，纳入了107,669例有旁观者目睹的心源性心脏骤停患者。主要结局是1个月后良好的脑功能预后，次要结局是EMS到达时心电图上可电击心律的发生率。将EMS到达现场的时间分为三分位数，即7分钟、8 - 10分钟和11 - 20分钟。使用多因素逻辑回归分析估计调整后的优势比（AOR）和95%置信区间（95%CI），以评估每个三分位数中DA-BCPR与结局之间的关联。
结果
DA-BCPR组、仅旁观者心肺复苏（Only-BCPR）组和无旁观者心肺复苏（no-BCPR）组分别有37,269例（35%）、18,109例（17%）和52,291例（49%）患者。与no-BCPR相比，无论从拨打119到EMS接触的时间如何，DA-BCPR都与良好的神经学结局相关（AOR分别为1.56、2.01、1.82；95%CI分别为1.43 - 1.71、1.80 - 2.24、1.52 - 2.19；≤7分钟、8 - 10分钟和11 - 20分钟）。无论从拨打119到EMS接触的时间如何，DA-BCPR都与EMS到达时的可电击心律发生率相关（AOR分别为1.30、,1.60、1.90；95%CI分别为1.23 - 1.38、1.51 - 1.70、1.75 - 2.06；≤7分钟、8 - 10分钟和11 - 20分钟）。
结论
无论患者年龄和EMS反应时间如何，为拨打,119的呼叫者提供调度员辅助的心肺复苏可改善长期结局。因此，鼓励调度员推广旁观者心肺复苏对于提高可电击心律发生率和改善脑功能预后很重要。
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