Abstract 296: Relationship between emergency medical service response time and bystander cardiopulmonary resuscitation in children with out-of-hospital cardiac arrest: A nationwide, population-based observational study
Abstract 296: Relationship between emergency medical service response time and bystander cardiopulmonary resuscitation in children with out-of-hospital cardiac arrest: A nationwide, population-based observational study
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摘要 296：院外心脏骤停儿童的紧急医疗服务响应时间与旁观者心肺复苏之间的关系：一项全国性的、基于人群的观察性研究
DOI：
10.1161/circ.146.suppl_1.296
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发表时间：
2022
期刊：
影响因子：
37.8
通讯作者：
Yoshikazu Goto
中科院分区：
文献类型：
--
作者：
Akira Funada;Yoshikazu Goto
简介：旁观者心肺复苏（CPR）和紧急医疗服务（EMS）的短响应时间是院外心脏骤停（OHCA）后生存的重要决定因素。由于窒息性心脏骤停比儿童原发性心脏事件引起的心脏骤停更常见，因此在儿科OHCA期间，有效的通气至关重要。假设：如果EMS响应时间极短，则在EMS到达之前，标准旁观者CPR（S-CPR）与人工呼吸和仅胸部按压的旁观者CPR（CC-CPR）之间的儿科OHCA后无差异。方法：该研究纳入了13，719名日本儿童（年龄<18岁），这些儿童来自全日本Utstein式注册表，他们在2005年至2019年期间接受了OHCA后的旁观者CPR。患者分为两组：S-CPR（n = 5，369）和CC-CPR（n = 8，350）。在倾向评分匹配后，我们根据EMS响应时间比较了组间的结果。EMS响应时间分为13组：≤2、3-4、5-6、7-8、9-10、11-12、13-14、15-16、17-18、19-20、21-22、23-24和≥25分钟。主要研究终点是1个月神经系统完整生存期，结果：5,369例S-CPR患者中有4,639例（86.4%）和8,350例CC-CPR患者中有4,639例（55.6%）达到了倾向评分匹配。S-CPR的总体1个月CPC 1-2率显著高于CC-CPR：17.0%（788/4,639）vs. 9.3%（429/4,639，P<0.0001）。当EMS响应时间为≤2 min（P= 0.17）、17-18 min（P= 0.55）、19-20 min（P= 0.14）、21-22 min（P = 0.23）、23-24 min（P= 1.00）和≥25 min（P= 0.07）时，S-CPR组和CC-CPR组的1个月CPC 1-2率无显著差异。结论：当EMS反应时间≤2 min和≥17 min时，CC-CPR与S-CPR在1个月神经功能完好生存率方面的相关性相似，当EMS反应时间为3-4 min（P <0.01）和15-16 min（P< 0.01）时，CC-CPR与S-CPR在1个月神经功能完好生存率方面的相关性相似。然而，当EMS反应时间超出此范围时，S-CPR的1个月神经系统完整生存率上级优于CC-CPR。
Introduction:Bystander cardiopulmonary resuscitation (CPR) and a short response time for emergency medical services (EMSs) are important determinants of survival after out-of-hospital cardiac arrest (OHCA). As asphyxia cardiac arrest is more common than cardiac arrest from a primary cardiac event in children, effective ventilation is vital during pediatric OHCA.Hypothesis:There would be no difference in post-pediatric OHCA between standard bystander CPR (S-CPR) with rescue breaths and chest-compression-only bystander CPR (CC-CPR) before EMS arrival if EMS response time is extremely short.Methods:The study included 13,719 Japanese children (aged <18 years) from an All Japan Utstein-style registry who received bystander CPR post-OHCA between 2005 and 2019. Patients were divided into two groups: S-CPR (n = 5,369) and CC-CPR (n = 8,350). After propensity score matching, we compared the outcomes between the groups according to EMS response time. EMS response times were categorized into 13 groups: ≤2, 3-4, 5-6, 7-8, 9-10, 11-12, 13-14, 15-16, 17-18, 19-20, 21-22, 23-24, and ≥25 min. The primary study endpoint was 1-month neurologically intact survival, defined as a cerebral performance category score of 1 or 2 (CPC 1-2).Results:Propensity score matching was achieved for 4,639 of 5,369 patients with S-CPR (86,4%) and 4,639 of 8,350 patients with CC-CPR (55.6%). Overall 1-month CPC 1-2 rate in S-CPR was significantly higher than that of CC-CPR: 17.0% (788/4,639) vs. 9.3% (429/4,639,P<0.0001). There were no significant differences in 1-month CPC 1-2 rate between S-CPR and CC-CPR groups when EMS response times were ≤2 min (P= 0.17), 17-18 min (P= 0.55), 19-20 min (P= 0.14), 21-22 min (P= 0.23), 23-24 min (P= 1.00), and ≥25 min (P= 0.07). However, the rate of 1-month CPC 1-2 was significantly higher with S-CPR than with CC-CPR when the EMS response time ranged 3-4 min (P< 0.01) to 15-16 min (P< 0.01).Conclusions:CC-CPR for children with OHCA before EMS arrival had a similar association with S-CPR for 1-month neurologically intact survival when EMS response time was ≤2 min and ≥17 min onward. However, 1-month neurologically intact survival in S-CPR was superior to CC-CPR when EMS response time was outside this range.