院外心脏骤停中旁观者与非专业施救者除颤后生存和神经功能结局：BOX 试验的一个亚组研究。

Survival and neurological outcome after bystander versus lay responder defibrillation in out-of-hospital cardiac arrest: A sub-study of the BOX trial.

机构信息

Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.

Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.

出版信息

Resuscitation. 2024 Feb;195:110059. doi: 10.1016/j.resuscitation.2023.110059. Epub 2023 Nov 25.

DOI:10.1016/j.resuscitation.2023.110059

PMID:38013147

Abstract

BACKGROUND AND AIM

Bystander defibrillation is associated with increased survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA). Dispatch of lay responders could increase defibrillation rates, however, survival with good neurological outcome in these remain unknown. The aim was to compare long-term survival with good neurological outcome in bystander versus lay responder defibrillated OHCAs.

METHODS

This is a sub-study of the BOX trial, which included OHCA patients from two Danish tertiary cardiac intensive care units from March 2017 to December 2021. The main outcome was defined as 3-month survival with good neurological performance (Cerebral Performance Category of 1or 2, on a scale from 1 (good cerebral performance) to 5 (death or brain death)). For this study EMS witnessed OHCAs were excluded.

RESULTS

Of the 715 patients, a lay responder arrived before EMS in 125 cases (16%). In total, 81 patients were defibrillated by a lay responder (11%), 69 patients by a bystander (10%) and 565 patients by the EMS staff (79%). The 3-month survival with good neurological outcome was 65% and 81% in the lay responder and bystander defibrillated groups, respectively (P = 0.03).

CONCLUSION

In patients with OHCA, 3-month survival with good neurological outcome was higher in bystander defibrillated patients compared with lay responder defibrillated patients.

摘要

背景与目的

院外心脏骤停（OHCA）后旁观者除颤与生存率提高和良好神经功能结局相关。派遣非专业急救人员可能会增加除颤率，但这些患者的生存率和良好神经功能结局仍不清楚。本研究旨在比较旁观者与非专业急救人员除颤的 OHCA 患者的长期生存率和良好神经功能结局。

方法

这是 BOX 试验的一项子研究，纳入了 2017 年 3 月至 2021 年 12 月来自丹麦两家三级心脏重症监护病房的 OHCA 患者。主要结局定义为 3 个月时具有良好神经功能表现的生存率（Cerebral Performance Category 为 1 或 2，评分范围为 1（良好的大脑功能）至 5（死亡或脑死亡））。本研究排除了有 EMS 见证的 OHCA。

结果

在 715 例患者中，有 125 例（16%）非专业急救人员在 EMS 到达前到达现场。共有 81 例患者由非专业急救人员除颤（11%），69 例患者由旁观者除颤（10%），565 例患者由 EMS 人员除颤（79%）。旁观者除颤组和非专业急救人员除颤组的 3 个月时具有良好神经功能结局的生存率分别为 65%和 81%（P=0.03）。