Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest.
Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest.
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DOI：
10.1161/jaha.117.007568
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发表时间：
2018-04-27
影响因子：
5.4
通讯作者：
Goto Y
中科院分区：
文献类型：
--
作者：
Goto Y;Funada A;Goto Y
紧急医疗服务（EMS）的响应时间是院外心脏骤停后存活的重要决定因素。我们试图确定EMS反应时间和旁观者干预与神经完整存活相关的上限。我们分析了2010年至2014年间日本登记的553 426例院外心脏骤停患者的记录。主要研究终点是1个月的神经功能完整生存（脑功能分类量表1或2）。EMS反应时间的增加与1个月神经系统完整存活的调整优势显著降低相关（每增加1分钟的调整优势比[aOR]为0.89；95%可信区间[CI]， 0.89 - 0.90），尽管这种关系被旁观者干预所改变。旁观者干预和EMS反应时间范围与调整后的1个月神经完整存活增加相关如下：旁观者除颤，从≤2分钟（aOR, 3.10 [95% CI, 1.25-7.31]）到13分钟（aOR, 5.55 [95% CI, 2.66-11.2]）；旁观者常规心肺复苏，从3分钟（aOR 1.48 [95% CI, 1.02-2.12]）到11分钟（aOR 2.41 [95% CI, 1.61-3.56]）；旁观者胸部按压心肺复苏，从≤2分钟（aOR 1.57 [95% CI, 1.01-2.25]）到11分钟（aOR 1.92 [95% CI, 1.45-2.56]）。然而，当EMS反应时间超出这些范围时，与没有接受旁观者干预的患者相比，接受旁观者干预的患者神经系统完整生存率的增加在统计学上不显著。当旁观者提供除颤（通常是心肺复苏）时，EMS反应时间的上限为13分钟，而当旁观者提供无除颤的心肺复苏时，EMS反应时间的上限为11分钟。
The response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. We analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges. The upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.