Scquizzato Tommaso, Belloni Olivia, Semeraro Federico, Greif Robert, Metelmann Camilla, Landoni Giovanni, Zangrillo Alberto
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan.
Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy.
Eur J Emerg Med. 2022 Jun 1;29(3):163-172. doi: 10.1097/MEJ.0000000000000915. Epub 2022 Mar 10.
Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.
许多国家都采用了手机技术，以提醒公民急救人员处理院外心脏骤停（OHCA）情况。本系统评价和荟萃分析旨在调查激活公民急救人员是否能增加旁观者的干预并改善治疗结果。我们检索了PubMed、EMBASE和Cochrane对照试验中央注册库，检索时间从建库至2021年11月24日，以查找比较在OHCA情况下激活公民急救人员与标准应急响应的研究。主要结局是出院时或30天时的存活情况。次要结局包括出院时神经功能良好、旁观者启动的心肺复苏（CPR）以及救护车到达前自动体外除颤器（AED）的使用情况。采用GRADE评估证据的确定性。我们的检索策略共获得1215篇文章。经过筛选，我们纳入了10项研究，共计23351例患者。与标准应急响应相比，激活公民急救人员的OHCA患者出院时或30天时的存活率更高[9项研究；903/9978（9.1%）对1104/13247（8.3%）；比值比（OR）为1.45；95%置信区间（CI）为1.21 - 1.74；P < 0.001]，自主循环恢复率更高[9项研究；2575/9169（28%）对3445/12607（27%）；OR为1.40；95%CI为1.07 - 1.81；P = 0.01]，旁观者启动的CPR发生率更高[8项研究；5876/9074（65%）对6384/11970（53%）；OR为1.75；95%CI为1.43 - 2.15；P < 0.001]，AED使用率更高[8项研究；654/9132（7.2%）对624/14848（4.2%）；OR为1.82；95%CI为1.31 - 2.53；P < 0.0
