Komori Akira, Iriyama Hiroki, Abe Toshikazu
Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.
Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
Resusc Plus. 2023 Feb 7;13:100363. doi: 10.1016/j.resplu.2023.100363. eCollection 2023 Mar.
Although defibrillation using automated external defibrillator (AED) by bystander prior to emergency medical system (EMS) arrival was associated with favorable outcomes in out-of-hospital cardiac arrest (OHCA) of cardiac cause, whether it improves outcomes of OHCA due to non-cardiac cause is not clear. We aimed to investigate the impact of defibrillation with AED by bystander before defibrillation by EMS personnel on the outcomes of OHCA of presumed non-cardiac cause.
This was a retrospective cohort study using the All-Japan Utstein registry (reference period: 2013 to 2017). We included adult patients with OHCA of presumed non-cardiac cause, who had initial shockable rhythm, and who received witnessed arrest bystander cardiopulmonary resuscitation (CPR). Exposure variable was defibrillation with AED by bystander in comparison with initial defibrillation by EMS. Logistic regression analyses were conducted to assess the association between bystander AED shock and favorable neurological outcome (Cerebral Performance Category scale 1 or 2) at one month.
Among the 1,053 patients included for analysis, 57 (5.4%) received bystander AED shock. There was no statistically significant difference in the rate of favorable neurological outcome at one month between groups [9 (15.8%) vs 109 (10.9%), p = 0.26]. Logistic regression analysis adjusted for characteristics, intervention, and time course of CPR showed no association between bystander AED shock and favorable neurological outcome [OR (95% CI): 1.63 (0.70-3.77), p = 0.25].
In this study, defibrillation with AED by bystander before defibrillation by EMS personnel was not associated with the favorable outcomes of OHCA of presumed non-cardiac cause.
尽管在紧急医疗系统（EMS）到达之前由旁观者使用自动体外除颤器（AED）进行除颤与心源性院外心脏骤停（OHCA）的良好预后相关，但对于它是否能改善非心源性OHCA的预后尚不清楚。我们旨在研究在EMS人员进行除颤之前由旁观者使用AED进行除颤对疑似非心源性OHCA预后的影响。
这是一项使用全日本Utstein登记处（参考期：2013年至2017年）的回顾性队列研究。我们纳入了疑似非心源性OHCA的成年患者，这些患者具有初始可电击心律，并且接受了旁观者目击的心脏骤停心肺复苏（CPR）。暴露变量是旁观者使用AED进行除颤与EMS的初始除颤相比较。进行逻辑回归分析以评估旁观者AED电击与1个月时良好神经学预后（脑功能分类量表1或2）之间的关联。
在纳入分析的1053例患者中，57例（5.4%）接受了旁观者AED电击。两组之间1个月时良好神经学预后的发生率没有统计学上的显著差异[9例（15.8%）对109例（10.9%）, p = 0.26]。针对CPR的特征、干预和时间过程进行调整的逻辑回归分析显示，旁观者AED电击与良好神经学预后之间没有关联[比值比（95%可信区间）：1.63（0.70 - 3.77）, p = 0.25]。
在本研究中，在EMS人员进行除颤之前由旁观者使用AED进行除颤与疑似非心源性OHCA的良好预后无关。
