Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest - Survival implications of guideline changes
Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest - Survival implications of guideline changes
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DOI：
10.1161/circulationaha.106.654715
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发表时间：
2006-12-19
期刊：
影响因子：
37.8
通讯作者：
Eisenberg, Mickey
中科院分区：
文献类型：
--
作者：
Rea, Thomas D.;Helbock, Michael;Eisenberg, Mickey
背景-最新的复苏指南试图改善除颤和心肺复苏之间的相互作用;然而，这些变化对生存率的影响尚不清楚。在最新指南发布前一年，我们实施了方案变更，提供了单次电击，而没有心律再分析、叠加电击或除颤后脉冲检查，并将心肺复苏时间从1分钟延长至2分钟。我们假设，生存将更好地与新protocol.Methods和结果-本研究发生在一个社区与2层的紧急医疗服务响应和建立系统的心脏骤停监测，培训和审查。这项调查是一项队列研究，研究对象是因心脏病而在院外室颤停搏的旁观者，（2005年1月1日至2006年1月31日）与根据既往心律再分析、叠加电击和除颤后脉搏检查指南进行治疗的历史对照组（2002年1月1日至2004年12月31日）。主要结局是出院时的生存率。干预期和对照期符合入选标准的经治疗心脏骤停的比例相似（15.4% [134/869] vs 16.6% [374/2255]）。与对照组相比，干预组患者出院存活率显著更高（46% [61/134] vs 33% [122/374]，P=0.008），这与休克至开始胸外按压的间隔时间缩短（28秒vs 7秒）相对应。协变量的调整并没有改变生存association.Conclusions -这些结果表明，新的复苏指南将改变除颤和心肺复苏之间的接口，反过来可能会改善结果。
Background - The most recent resuscitation guidelines have sought to improve the interface between defibrillation and cardiopulmonary resuscitation; the survival impact of these changes is unknown, however. A year before issuance of the most recent guidelines, we implemented protocol changes that provided a single shock without rhythm reanalysis, stacked shocks, or postdefibrillation pulse check, and extended the period of cardiopulmonary resuscitation from 1 to 2 minutes. We hypothesized that survival would be better with the new protocol.Methods and Results - The present study took place in a community with a 2-tiered emergency medical services response and an established system of cardiac arrest surveillance, training, and review. The investigation was a cohort study of persons who had bystander-witnessed out-of-hospital ventricular fibrillation arrest because of heart disease, comparing a prospectively defined intervention group (January 1, 2005, to January 31, 2006) with a historical control group that was treated according to previous guidelines of rhythm reanalysis, stacked shocks, and postdefibrillation pulse checks (January 1, 2002, to December 31, 2004). The primary outcome was survival to hospital discharge. The proportion of treated arrests that met inclusion criteria was similar for intervention and control periods (15.4% [134/869] versus 16.6% [374/2255]). Survival to hospital discharge was significantly greater during the intervention period compared with the control period (46% [61/134] versus 33% [122/374], P=0.008) and corresponded to a decrease in the interval from shock to start of chest compressions (28 versus 7 seconds). Adjustment for covariates did not alter the survival association.Conclusions - These results suggest the new resuscitation guidelines will alter the interface between defibrillation and cardiopulmonary resuscitation and in turn may improve outcomes.