Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States.
Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States.
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在美国，旁观者进行心肺复苏的时间延迟与目击心脏骤停的生存率之间的关系。
DOI：
10.1161/circoutcomes.123.010116
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Chan,PaulS
中科院分区：
文献类型：
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作者：
Nguyen,DanD;Spertus,JohnA;Kennedy,KevinF;Gupta,Kashvi;Uzendu,AneziI;McNally,BryanF;Chan,PaulS
背景：迅速启动旁观者心肺复苏（CPR）对院外心脏骤停（OHCA）患者的生存至关重要。然而，旁观者CPR延迟与OHCA存活之间的关系尚不清楚。方法：在这项观察性研究中，我们使用了具有全国代表性的美国注册表，我们确定了2013年至2021年期间在有证人的OHCA中接受旁观者CPR的患者。分层逻辑回归用于估计心肺复苏术的时间（<1分钟相对于2 - 3、4-5、6-7、8-9和≥10分钟的间隔）与出院时的生存和良好的神经系统生存（存活至出院时脑功能类别为1或2[即无严重神经功能障碍]）之间的关系。结果78 048例经旁观者CPR治疗的OHCA患者中，平均年龄为63.5±15.7岁，女性25197例（32.3%）。到旁观者CPR的中位时间为2（1-5）分钟，10%的患者在开始CPR前延迟≥10分钟。总体而言，15 000例（19.2%）患者存活至出院，13 159例（16.9%）患者神经系统存活良好。接受旁观者心肺复苏术的时间与出院前的生存率呈分级负相关（趋势p <0.001）。与在1分钟内接受心肺复苏术的患者相比，心肺复苏术时间为2至3分钟的患者存活至出院的可能性降低9%（校正优势比为0.91 [95% CI, 0.87-0.95]），心肺复苏术时间为4至5分钟的患者存活的可能性降低27%（校正优势比为0.73 [95% CI, 0.68-0.77]）。旁观者心肺复苏术的时间与有利的神经系统生存之间也存在类似的分级负相关（趋势p <0.001）。结论在目睹OHCA的患者中，旁观者延迟启动CPR与较低生存率之间存在剂量-反应关系。
BACKGROUNDPrompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood.METHODSIn this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR (<1 minute versus 2–3, 4–5, 6–7, 8–9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]).RESULTSOf 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1–5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge (Pfor trend <0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87–0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68–0.77]). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival (Pfor trend <0.001).CONCLUSIONSAmong patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.