Abstract 289: The Relationship of Chest Compression Rate and Survival During Out-of-Hospital Cardiopulmonary Resuscitation at Resuscitation Outcomes Consortium (ROC) Regional Sites
Abstract 289: The Relationship of Chest Compression Rate and Survival During Out-of-Hospital Cardiopulmonary Resuscitation at Resuscitation Outcomes Consortium (ROC) Regional Sites
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摘要 289：复苏结果联盟 (ROC) 区域站点院外心肺复苏期间胸外按压率与生存率的关系
作者：
A. Idris;D. Guffey;P. Pepe;M. Daya;D. Davis;I. Stiell;J. Menegazzi;C. Callaway;J. Christenson;Randal Gray;D. Boyce;Steve Lin;Kellie L. Sheehan;T. Aufderheide
背景：
目前美国心脏协会关于心肺复苏(CPR)的指南建议胸部按压速度至少为100次/分钟。动物和人类的心肺复苏研究已经报道了与胸部按压速度≥120/分钟相关的血流改善，但很少有报道院外(OOH)心肺复苏期间使用的比率，或者比率与结果之间的关系。
目标：
描述急诊医疗服务(EMS)提供者用来复苏心跳骤停患者的胸部按压比率，并确定比率和结果之间的关系。
方法：
纳入纳入ROC Primed研究的20岁≥患者，这些患者的心跳骤停由急救服务提供者治疗。数据从心肺复苏前5分钟的监护仪-除颤器记录中提取。多因素Logistic回归分析胸腔按压率和预后之间的关系。该模型根据性别、年龄、旁观者和急救人员目击逮捕、旁观者心肺复苏未遂、公共场所和中华民国地点进行了调整。
结果：
从2007年6月至2009年11月，10,330名患者进行了OORT。平均年龄67±16岁。心肺复苏前5分钟平均胸压111±19(3~210)次/min。34%的患者自主循环恢复，9%的患者存活至出院。与参考心率(100~120/min)(平均109±6)比较，调整后的生存优势比(OR)分别为：0~80/min(平均68±13)或1.18(CI 0.78~1.77)，80~100/min(平均93±5)或0.88(0.73~1.06)，120~140/min(平均128±5)或0.88(CI 0.73~1.08)，>；140/min(平均151±11)或0.77(CI 0.54~1.11)。三次样条曲线表明，生存峰值约为120次/分钟，然后以120次/分钟的速度下降。
结论：
胸部按压速度超过100次/分钟是很常见的。这项研究表明，心跳骤停后存活的可能性随着压缩速率的增加而降低。
Background:
Current American Heart Association guidelines for cardiopulmonary resuscitation (CPR) recommend a chest compression rate of at least 100 compressions/min. Animal and human CPR studies have reported improved blood flow associated with chest compressions rates ≥ 120/min, but few have reported rates used during out-of-hospital (OOH) CPR, or the relationship between rate and outcome.
Objective:
To describe chest compression rates used by emergency medical services (EMS) providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between rate and outcome.
Methods:
Included were patients ≥ 20 years old enrolled in the ROC PRIMED study with OOH cardiac arrest treated by EMS providers. Data were abstracted from monitor-defibrillator recordings during the first 5 minutes of CPR. Multiple logistic regression assessed the association between chest compression rate and outcome. The model adjusted for sex, age, bystander and EMS witnessed arrest, attempted bystander CPR, public location, and ROC site.
Results:
10,330 patients had OOH CPR from June 2007 to November 2009. Mean age was 67 ± 16. Mean chest compression rate was 111 ± 19 (3 - 210) compressions/min during the first 5 minutes of CPR. Return of spontaneous circulation occurred in 34% and 9% survived to hospital discharge. Compared with the reference rate (100-120/min) (mean 109 ± 6), the adjusted odds ratios (OR) for survival were: compression rate from 0 - 80/min (mean 68 ± 13) OR 1.18 (CI 0.78 - 1.77), 80 - 100/min (mean 93 ± 5) OR 0.88 (0.73 - 1.06), 120 - 140/min (mean 128 ± 5) OR 0.88 (CI 0.73 - 1.08), >140/min (mean 151 ± 11) OR 0.77 (CI 0.54 - 1.11). A cubic spline curve suggests survival peaks at about 120/min and then declines at rates >120/min.
Conclusion:
Chest compression rates faster than 100/min were common. The study suggests that the likelihood of survival from OOH cardiac arrest is decreased with compression rates >120/min.