Public-access defibrillation and survival after out-of-hospital cardiac arrest
Public-access defibrillation and survival after out-of-hospital cardiac arrest
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DOI：
10.1056/nejmoa040566
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发表时间：
2004-08-12
影响因子：
158.5
通讯作者：
Kerr, A
中科院分区：
文献类型：
--
作者：
Hallstrom, AP;Ornato, JP;Kerr, A
背景：院外心脏骤停后的存活率很低。目前尚不清楚，如果非专业人员接受使用自动体外除颤器(AED)尝试除颤的培训，这一发生率是否会增加。方法：我们进行了一项基于社区的多中心前瞻性临床试验，我们随机分配社区单位(如购物中心和公寓大楼)到一个结构化和监控的应急反应系统中，这些非专业志愿者接受过单独的心肺复苏(CPR)培训或接受过CPR和使用AED的培训。结果：来自北美24个地区993个社区单位的19,000多名志愿者参与了研究。两个研究组有相似的单位和志愿者特征。两组接受院外心脏骤停治疗的患者在年龄(平均69.8岁)、男性比例(67%)、公共场所心脏骤停的发生率(70%)和目睹心脏骤停的比率(72%)方面相似。没有不适当的电击。与只接受CPR培训的志愿者(107人中有15人；P=0.03；相对风险为2.0；95%的可信区间为1.07至3.77)相比，被分配到接受CPR和使用AED培训的单位的出院幸存者(128名被捕患者中有30名幸存者)；在居民区只有2名幸存者。两组患者在出院时的功能状态没有差异。结论：培训和装备志愿者在结构化反应系统中尝试早期除颤可以增加公共场所院外心脏骤停后幸存者出院的数量。训练有素的非专业人员可以安全有效地使用AEDs。
Background: The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators (AEDs).Methods: We conducted a prospective, community-based, multicenter clinical trial in which we randomly assigned community units (e.g., shopping malls and apartment complexes) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation (CPR) alone or in CPR and the use of AEDs. The primary outcome was survival to hospital discharge.Results: More than 19,000 volunteer responders from 993 community units in 24 North American regions participated. The two study groups had similar unit and volunteer characteristics. Patients with treated out-of-hospital cardiac arrest in the two groups were similar in age (mean, 69.8 years), proportion of men (67 percent), rate of cardiac arrest in a public location (70 percent), and rate of witnessed cardiac arrest (72 percent). No inappropriate shocks were delivered. There were more survivors to hospital discharge in the units assigned to have volunteers trained in CPR plus the use of AEDs (30 survivors among 128 arrests) than there were in the units assigned to have volunteers trained only in CPR (15 among 107; P=0.03; relative risk, 2.0; 95 percent confidence interval, 1.07 to 3.77); there were only 2 survivors in residential complexes. Functional status at hospital discharge did not differ between the two groups.Conclusions: Training and equipping volunteers to attempt early defibrillation within a structured response system can increase the number of survivors to hospital discharge after out-of-hospital cardiac arrest in public locations. Trained laypersons can use AEDs safely and effectively.