Response by Pollack and Weisfeldt to Letter Regarding Article, "Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests".
Response by Pollack and Weisfeldt to Letter Regarding Article, "Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests".
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Pollack 和 Weisfeldt 对有关文章“旁观者自动体外除颤器使用对可电击观察到的公共心脏骤停中的生存和功能结果的影响”的信件的回应。
DOI：
10.1161/circulationaha.118.036946
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发表时间：
2018
期刊：
影响因子：
37.8
通讯作者：
Weisfeldt,MyronL
中科院分区：
文献类型：
--
作者：
Pollack,RossA;Weisfeldt,MyronL
Karam 及其合作者在信中对本文 1 提出了许多赞赏的赞美，但也提出了警告，即除了使用自动体外除颤器 (AED) 之外，旁观者可能为提高患者生存率而做出的其他努力可能会产生混淆。与任何队列研究一样，总有一些因素无法或无法测量。这封信的作者正确地指出，接受过使用 AED 培训的旁观者可能会比不使用 AED 的旁观者更快地呼叫紧急医疗服务 (EMS)，并且可能会以更好的质量进行心肺复苏。我们目前无法定量确定这些担忧是否有效。尽管许多研究报告了从逮捕开始到要求紧急医疗服务的时间间隔，但这些充其量只是来自一个可以理解的紧张旁观者的回顾性陈述；这些估计已被证明是不可靠的。 2 此外，尽管复苏结果联盟网络在美国和加拿大的许多 EMS 系统中率先开展了心肺复苏定量评估，但监测心肺复苏质量措施的 AED 的使用仍然有限。因此，我们必须承认这些限制。值得注意的是，旁观者 AED 应用还可以减少 EMS 行动的延迟，因为即使心律不可电击，衣服也会被脱掉，导联也已就位。
The letter by Karam and collaborators offers a number of appreciated compliments about this article 1 but offers a caution related to potential confounding from other efforts that bystanders may make to improve survival in patients aside from using an automatic external defibrillator (AED).As with any cohort study, there are always factors that cannot or are not measured. The authors of the letter are correct in stating that bystanders trained to apply an AED may have called an emergency medical service (EMS) with less delay and may have performed cardiopulmonary resuscitation with better quality than a bystander not using an AED. We are not currently able to determine quantitatively whether these concerns are valid. Although many studies report time intervals from the onset of arrest to call for EMS, these are at best retrospective statements from an understandably stressed bystander; these estimations have been shown to be unreliable. 2 In addition, although the Resuscitation Outcomes Consortium network pioneered cardiopulmonary resuscitation quantitative assessment in many US and Canadian EMS systems, there has been only limited use of AEDs that monitor cardiopulmonary resuscitation quality measures. Thus, we must acknowledge these limitations. It might be noted that bystander AED application may also provide benefit in less delay for EMS to act because clothing is removed and leads are in place even if the rhythm is nonshockable.