Benkerrou Hizia, Lockhart Marguerite, Heidet Matthieu, Azzouz Ramy, Vilhelm Christian, Hubert Hervé, Recher Morgan, Baert Valentine
Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques Médicales, F-59000 Lille, France.
French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France.
Resusc Plus. 2025 Jan 2;21:100858. doi: 10.1016/j.resplu.2024.100858. eCollection 2025 Jan.
Early bystander interventions are associated with more favorable outcomes after out-of-hospital cardiac arrest (OHCA). The objective of the present study was to determine whether the type of bystander-patient relationship was associated with survival and neurological outcomes after OHCA in France.
We analyzed data registered in the French National Cardiac Arrest Registry (RéAC) between July 1st, 2011, and April 30th, 2023. The study population comprised bystander-attended cases of OHCA managed by the emergency medical services. Bystanders were categorized as family members, other laypersons, off-duty professional first responders, or off-duty healthcare professionals. The primary outcome was 30-day survival with a favorable neurological outcome (Cerebral Performance Category 1 or 2). The secondary outcomes included the bystander cardiopulmonary resuscitation (CPR) initiation rate, return of spontaneous circulation, and survival upon admission to the hospital. Our statistical analyses were based on bivariate and multivariable logistic regressions analyses.
Among the 89,861 OHCA cases analyzed, family members constituted the largest group of bystanders (69.2%). Compared with non-family-member bystanders, family bystander status was associated with a lower CPR initiation rate, a longer no-flow time, and lower 30-day survival rates. Specifically, cases of OHCA with non-family-member bystanders were 32% more likely to survive with a CPC of 1-2 at day 30 than cases with family member bystanders. Medically trained bystander status (off-duty professional first responders and healthcare professionals) was associated with higher CPR initiation and 30-day survival rates, relative to nontrained laypersons.
Survival after an OHCA appears to be associated with the type of bystander. Although family members were the most common bystanders, they were less likely to initiate CPR and less likely to see the OHCA patient survive. Efforts to increase the post-OHCA survival rate should include targeted interventions (such as public education and training programs) that emphasize the importance of early CPR and automated external defibrillator use by family members.
院外心脏骤停（OHCA）后，早期旁观者干预与更有利的结果相关。本研究的目的是确定在法国，旁观者与患者的关系类型是否与OHCA后的生存及神经功能结局相关。
我们分析了2011年7月1日至2023年4月30日期间在法国国家心脏骤停登记处（RéAC）登记的数据。研究人群包括由紧急医疗服务机构处理的旁观者参与的OHCA病例。旁观者被分为家庭成员、其他非专业人员、休班专业急救人员或休班医护人员。主要结局是30天存活且神经功能结局良好（脑功能分类1或2）。次要结局包括旁观者心肺复苏（CPR）启动率、自主循环恢复情况以及入院时的存活情况。我们的统计分析基于双变量和多变量逻辑回归分析。
在分析的89,861例OHCA病例中，家庭成员是最大的旁观者群体（69.2%）。与非家庭成员旁观者相比，家庭成员旁观者身份与较低的CPR启动率、较长的无血流时间和较低的30天生存率相关。具体而言，在第30天时，有非家庭成员旁观者的OHCA病例存活且脑功能分类为1 - 2的可能性比有家庭成员旁观者的病例高32%。相对于未受过训练的非专业人员，受过医学培训的旁观者身份（休班专业急救人员和医护人员）与较高的CPR启动率和30天生存率相关。
OHCA后的生存似乎与旁观者类型有关。尽管家庭成员是最常见的旁观者，但他们启动CPR的可能性较小，且OHCA患者存活的可能性也较小。提高OHCA后生存率的努力应包括有针对性的干预措施（如公众教育和培训项目），强调家庭成员早期进行CPR和使用自动体外除颤器的重要性。
