Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study
Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study
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DOI：
10.1136/bmj.325.7363.515
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发表时间：
2002-09-07
影响因子：
--
通讯作者：
Cobbe, SM
中科院分区：
文献类型：
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作者：
Pell, JP;Sirel, JM;Cobbe, SM
目的评估使用公共呼吸机对院外心脏骤停患者总生存率的潜在影响。采用统计学模型评估在合适或可能合适的地点放置公共通道呼吸机对生存率的影响。设置苏格兰救护车服务。受试者记录1991- 1998年苏格兰所有因心脏病导致的院外心脏骤停。主要结果测量观察和预测出院生存率。结果在15189例心脏骤停中，12 004宗（79.0%）发生在不适合设置公众通道式空调器的地点，453宗（3.0%）发生在可能适合设置公众通道式空调器的地点，而2732宗（18.0%）发生在适合设置公众通道式空调器的地点。除颤器在67.9%的逮捕发生在可能合适的地点定位除颤器和72.9%的逮捕发生在合适的网站。与实际总生存率744（5.0%），使用公共通道呼吸机的预测生存率范围为942（6.3%）至959人（6.5%），结论：有针对性地提供公共接入除颤器所预测的生存率增加低于通过扩大第一反应除颤器，非救护人员，如警察或消防员，或旁观者心肺复苏。由于生存率略有改善，因此可能没有理由为大规模覆盖公众使用的呼吸机提供额外资源。
Objective To estimate the potential impact of public access defibrillators on overall survival after out of hospital cardiac arrest.Design Retrospective cohort study using data from an electronic register. A statistical model was used to estimate the effect on survival of placing public access defibrillators at suitable or possibly suitable sites.Setting Scottish Ambulance Service.Subjects Records of all out of hospital cardiac arrests due to heart disease in Scotland in 1991-8.Main outcome measures Observed and predicted survival to discharge from hospital.Results Of 15 189 arrests, 12 004 (79.0%) occurred in sites not suitable for the location of public access defibrillators, 453 (3.0%) in sites where they may be suitable, and 2732 (18.0%) in suitable sites. Defibrillation was given in 67.9% of arrests that occurred in possibly suitable sites for locating defibrillators and in 72.9% of arrests that occurred in suitable sites. Compared with an actual overall survival of 744 (5.0%), the predicted survival with public access defibrillators ranged from 942 (6.3%) to 959 (6.5%), depending on the assumptions made regarding defibrillator coverage.Conclusions The predicted increase in survival from targeted provision of public access defibrillators is less than the increase achievable through expansion of first responder defibrillation to non-ambulance personnel, such as police or firefighters, or of bystander cardiopulmonary resuscitation. Additional resources for wide scale coverage of public access defibrillators are probably not justified by the marginal improvement in survival.