Cardiac arrest survival did not increase in the Resuscitation Outcomes Consortium after implementation of the 2005 AHA CPR and ECC guidelines
Cardiac arrest survival did not increase in the Resuscitation Outcomes Consortium after implementation of the 2005 AHA CPR and ECC guidelines
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DOI：
10.1016/j.resuscitation.2011.03.024
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发表时间：
2011-08-01
期刊：
影响因子：
6.5
通讯作者：
Morrison, Laurie J.
中科院分区：
文献类型：
--
作者：
Bigham, Blair L.;Koprowicz, Kent;Morrison, Laurie J.
导言：我们检验了2005年美国心脏协会指南对复苏结果联盟(ROC)心脏骤停患者存活率的影响。方法：我们调查了8个ROC地点的174家急救机构，以确定2005年AHA指南的实施或交叉实施日期。在指南发布之前，两个具有2005年兼容治疗算法的站点和在研究期间没有采用新指南的机构被排除在外。非创伤性成人心脏骤停，没有EMS目击的，也没有没有复苏命令的包括在内。生存控制采用线性混合效应模型。结果：在174个机构中，85个机构在2005/12/01至2007/05/31的18个月期间向两个队列贡献了病例。7779例中，5054例发生在交叉前13个月(中位数)，2725例发生在交叉后5个月(中位数)。总存活率为6.1%；老年队列为5.8%，而老年队列为6.5%，p=0.23。VF/VT患者的存活率分别为14.6%和18.0%，p=0.063。我们的模型估计生存率不会随着时间的推移而增加(每月OR 1.014，95%CI 0.988，1.041，p=0.28)。结论：本研究发现在实施后的最初几个月，生存率没有显著变化。还需要进一步的纵向研究，以确定指南对生存的全部影响，以及在EMS中快速有效地转化知识的方法。(C)2011爱思唯尔爱尔兰有限公司。保留所有权利，
Introduction: We examined the effect of the 2005 American Heart Association guidelines on survival in the Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry.Methods: We surveyed 174 EMS agencies from 8 of 10 ROC sites to determine 2005 AHA guideline implementation, or crossover, date. Two sites with 2005 compatible treatment algorithms prior to guideline release, and agencies that did not adopt the new guidelines during the study period were excluded. Non-traumatic adult cardiac arrests that were not witnessed by EMS, and did not have do not resuscitate orders were included. A linear mixed effects model was applied for survival controlling for time and agency. The "crossover" date was added to the model to determine the effect of the 2005 guidelines.Results: Of 174 agencies, 85 contributed cases to both cohorts during the 18 month period between 2005/12/01 and 2007/05/31. Of 7779 cases, 5054 occurred during the 13 month (median) interval before crossover and 2725 occurred in the five month (median) interval after crossover. The overall survival rate was 6.1%; 5.8% in the old cohort vs. 6.5%, p = 0.23. For VF/VT patients, survival was 14.6% vs. 18.0%, p = 0.063. Our model estimated no increase in survival over time (monthly OR 1.014,95% Cl 0.988, 1.041, p = 0.28).Conclusion: This study found no significant change in survival rate over time in the early months after implementation. Further longitudinal study is needed to determine the full impact of the guidelines on survival and methods to translate knowledge quickly and effectively in EMS. (C) 2011 Elsevier Ireland Ltd. All rights reserved,