Cash Rebecca E, Nassal Michelle, Keseg David, Panchal Ashish R
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH, USA.
Resusc Plus. 2022 Jul 16;11:100274. doi: 10.1016/j.resplu.2022.100274. eCollection 2022 Sep.
It is unclear how best to identify "high-risk" areas for out-of-hospital cardiac arrest (OHCA) and if neighborhood-level interventions improve bystander cardiopulmonary resuscitation (BCPR). Our objectives were to 1) identify and compare community characteristics between high and low-risk neighborhoods; and 2) examine change in BCPR after a targeted hands-only CPR intervention.
This was a cross-sectional analysis of OHCA events in Franklin County, Ohio between 1/1/2010-12/31/2017. Adult (≥18 years) OHCAs in a non-healthcare setting with emergency medical services resuscitation attempted were included. High-risk neighborhoods based on OHCA incidence and BCPR rates were identified using global Empirical Bayes, Local Moran's I, and spatial scan statistic. We compared characteristics of high and low-risk neighborhoods and examined change in BCPR.
From the 3,841 included OHCAs, the mean adjusted OHCA incidence per census tract was 0.81 per 1,000, BCPR rate was 37.2%, and survival to hospital discharge was 11.5%. Of the 35 census tracts identified as high-risk, ten persisted from previous work. OHCA incidence was higher in high-risk neighborhoods (1.30 per 1,000 vs. 0.73, p < 0.001) and BCPR rates were lower (30.2% vs. 38.5%, p < 0.001). There were significant differences in characteristics between high and low-risk neighborhoods (e.g., Black population: 45.3% vs. 25.7%, p < 0.001). The neighborhoods targeted for the community education intervention had similar pre- and post-intervention BCPR rates.
Demographic and socioeconomic characteristics differed between high- and low-risk neighborhoods. BCPR rates were lower in high-risk neighborhoods despite a targeted BCPR intervention. Educational interventions may be necessary, but not sufficient, to improve OHCA outcomes.
目前尚不清楚如何最好地识别院外心脏骤停（OHCA）的“高风险”区域，以及社区层面的干预措施是否能改善旁观者心肺复苏（BCPR）情况。我们的目标是：1）识别并比较高风险和低风险社区的社区特征；2）研究在进行有针对性的单纯胸外按压心肺复苏干预后BCPR的变化情况。
这是一项对2010年1月1日至2017年12月31日期间俄亥俄州富兰克林县OHCA事件的横断面分析。纳入在非医疗环境中尝试进行紧急医疗服务复苏的成年（≥18岁）OHCA病例。使用全局经验贝叶斯、局部莫兰指数I和空间扫描统计方法，根据OHCA发病率和BCPR率确定高风险社区。我们比较了高风险和低风险社区的特征，并研究了BCPR的变化情况。
在纳入的3841例OHCA病例中，每人口普查区经调整后的OHCA平均发病率为每1000人0.81例，BCPR率为37.2%，出院存活率为11.5%。在确定为高风险的35个人口普查区中，有10个与之前的研究一致。高风险社区的OHCA发病率更高（每1000人1.30例对0.73例，p<0.001），BCPR率更低（30.2%对38.5%，p<0.001）。高风险和低风险社区在特征方面存在显著差异（例如，黑人人口：45.3%对25.7%，p<0.001）。接受社区教育干预的社区在干预前后的BCPR率相似。
高风险和低风险社区在人口统计学和社会经济特征方面存在差异。尽管进行了有针对性的BCPR干预，但高风险社区的BCPR率仍然较低。教育干预可能是必要的，但不足以改善OHCA的结局。
