Albargi H, Mallett S, Berhane S, Booth S, Hawkes C, Perkins G D, Norton M, Foster T, Scholefield B
Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Emergency Medical Services Department, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia.
UCL Centre for Medical, University College London, London W1W 7TY, UK.
Resuscitation. 2022 Jan;170:17-25. doi: 10.1016/j.resuscitation.2021.10.042. Epub 2021 Nov 5.
Bystander cardiopulmonary resuscitation (BCPR) is strongly advocated by resuscitation councils for paediatric out-of-hospital cardiac arrests (OHCAs). However, there are limited reports on rates of BCPR in children and its relationship with return of spontaneous circulation (ROSC) or survival outcomes.
We describe the rate of BCPR and its association with any ROSC and survival- to- hospital-discharge.
We conducted retrospective analysis of prospectively collected paediatric (<18 years of age) OHCA cases in England; we included specialist registry patients treated by emergency medical services (EMS) with known BCPR status and outcome between January 2014 and November 2018. Data included patient demographics, aetiology, witness status, initial rhythm, EMS, season, time of day and bystander status. Associations between BCPR, and any ROSC and survival-to-hospital-discharge outcomes were explored using multivariable logistic regression.
There were 2363 paediatric OHCAs treated across 11 EMS regions. BCPR was performed in 69.6% (1646/2363) of the cases overall (range 57.7% (206/367) to 83.7% (139/166) across EMS regions). Only 34.9% (550/1572) of BCPR cases were witnessed. Overall, any ROSC was achieved in 22.8% (523/2289) and survival to hospital discharge in 10.8% (225/2066). Adjusted odds ratio (aOR) for any ROSC was significantly improved following BCPR compared to no BCPR (aOR 1.37, 95% CI 1.03-1.81), but adjusted odds ratio for survival-to-hospital-discharge were similar (aOR 1.01, 95% CI 0.66-1.55).
BCPR was associated with improved rates of any ROSC but not survival-to-hospital-discharge. Variations in EMS BCPR rates may indicate opportunities for regional targeted increase in public BCPR education.
旁观者心肺复苏术（BCPR）得到了复苏委员会对儿童院外心脏骤停（OHCA）的强烈倡导。然而，关于儿童BCPR的实施率及其与自主循环恢复（ROSC）或生存结局的关系的报道有限。
我们描述了BCPR的实施率及其与任何ROSC和出院生存率的关联。
我们对英格兰前瞻性收集的儿科（<18岁）OHCA病例进行了回顾性分析；我们纳入了2014年1月至2018年11月期间由紧急医疗服务（EMS）治疗的已知BCPR状态和结局的专科登记患者。数据包括患者人口统计学、病因、目击者状态、初始心律、EMS、季节、一天中的时间和旁观者状态。使用多变量逻辑回归探讨BCPR与任何ROSC以及出院生存率之间的关联。
11个EMS地区共治疗了2363例儿科OHCA。总体而言，69.6%（1646/2363）的病例实施了BCPR（各EMS地区的范围为57.7%（206/367）至83.7%（139/166））。只有34.9%（550/1572）的BCPR病例有目击者。总体而言，22.8%（523/2289）的患者实现了任何ROSC，10.8%（225/2066）的患者存活至出院。与未进行BCPR相比，进行BCPR后任何ROSC的调整优势比（aOR）显著提高（aOR 1.37，95%CI 1.03-1.81），但出院生存率的调整优势比相似（aOR 1.01，95%CI 0.66-1.55）。
BCPR与任何ROSC的发生率提高相关，但与出院生存率无关。EMS的BCPR率差异可能表明有机会在区域内有针对性地加强公众BCPR教育。
