Stiell I G, Wells G A, DeMaio V J, Spaite D W, Field B J, Munkley D P, Lyver M B, Luinstra L G, Ward R
Division of Emergency Medicine, Department of Medicine, and Ottawa Hospital Loeb Research Institute, University of Ottawa, Ontario, Canada.
Ann Emerg Med. 1999 Jan;33(1):44-50. doi: 10.1016/s0196-0644(99)70415-4.
This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care.
This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses.
From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age.81 (. 73,.89), bystander-witnessed arrest 4.05 (2.78, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped.76 (.71,.82).
This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and clearly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.
本研究旨在确定在一个配备基本生命支持/除颤（BLS-D）护理水平的大型多中心急救医疗服务（EMS）系统中，与院外心脏骤停患者生存相关的可改变因素。
这项观察性队列研究是安大略省院外高级生命支持（OPALS）研究三阶段中的第一阶段。研究对象包括在21个城市/郊区社区中，在急救医疗服务到达之前发生心脏骤停的所有成年人。这些社区由1个救护车服务分支机构管辖，拥有911电话服务，提供救护车除颤但不提供院前高级生命支持（ALS）。根据Utstein指南对中央调度和救护车记录进行审查。通过单因素分析，然后逐步进行逻辑回归分析，评估多个患者因素和急救医疗服务因素与出院生存之间的关联。
从1991年1月1日至1995年1月31日，共治疗了5335例符合条件的患者。其中，46.8%的心脏骤停事件由市民目击，14.5%的患者接受了旁观者心肺复苏（CPR），25.6%的患者接受了消防或警察的CPR，38.2%的患者初始心律为心室颤动/室性心动过速（VF/VT）。从接到呼叫到车辆停下的平均间隔时间为6.7分钟。总体生存率为3.5%，VF/VT患者的生存率为8.8%。多因素分析发现以下因素与生存独立相关（比值比及95%置信区间）：年龄≥81岁（0.73，0.89）、旁观者目击的心脏骤停4.05（2.78，5.90）、旁观者CPR 2.98（2.07，4.29）、消防或警察进行的CPR 2.20（1.46，3.31）以及接到呼叫到车辆停下的反应间隔0.76（0.71，0.82）。
这是迄今为止开展的最大规模的多中心院外心脏骤停BLS-D研究，明确表明通过优化急救医疗服务反应间隔、旁观者CPR以及消防或警察的第一反应者CPR，可能会提高患者生存率。
