'Event tree' analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR
'Event tree' analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR
复制标题
DOI：
10.1016/s0300-9572(02)00343-x
复制
发表时间：
2003-02-01
期刊：
影响因子：
6.5
通讯作者：
Clarke, P
中科院分区：
文献类型：
--
作者：
Dowie, R;Campbell, H;Clarke, P
目标：英国国家心脏病服务框架 (NSF) 赞扬“乌特斯坦风格”审计院外心脏骤停。 NSF 还制定了院前治疗和响应时间的标准。为了提高 Utstein 的灵活性，提出了“事件树”技术作为审计工具。事件树由节点和分支组成，在这些节点和分支上输入数字、百分比或概率值。方法：利用伦敦救护车服务中心 (LAS) 1997 年 3759 例院外心脏骤停数据库，分析了由非专业旁观者或无人目睹的 2772 例心脏骤停，重点关注旁观者心肺复苏 (BCPR) 和反应时间。结果：Utstein 模板显示，接受 BCPR 的心室颤动 (VF) 或室性心动过速 (VT) 骤停患者在现场实现自主循环 (ROSC) 恢复的频率显着高于非 BCPR 接受者，分别为 26% 和 16%（P = 0.006）。但 BCPR 接受者入住医院并活着出院的可能性仅稍好一些。为了检查 BCPR 对呈现节律的影响，事件树显示，在 48% 目击的 BCPR 病例中，呈现节律为 VF/VT，而对于目击的非 BCPR 病例，27% 为 VF/VT (P < 0.0001)。在无人目击的逮捕中，31% 的 BCPR 病例出现室颤/室性心动过速，而非 BCPR 病例的这一比例为 18% (P < 0.0001)。 66% 的室颤/室性心动过速逮捕中，呼叫现场的时间少于 8 分钟。结论：事件树与 Utstein 模板相结合，证明了在监测绩效标准时全面检查目击和未目击心脏骤停数据集的重要性。分析还强调了大伦敦社区项目对于教授基本救生技能的相关性。 (C) 2002 Elsevier Science Ireland Ltd. 保留所有权利。
Objective: The British National Service Framework (NSF) for heart disease commended the 'Utstein style' for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an 'event tree' technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered. Methods: Using the London Ambulance Service's (LAS) 1997 database on 3759 out-of-hospital cardiac arrests, 2772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times. Results: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients-26 versus 16% (P = 0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (P < 0.0001). With unwitnessed arrests, 31% of BCPR cases were in VF/VT compared with 18% for non-BCPR cases (P < 0.0001). Call to scene time was less than 8 min for 66% of all VF/VT arrests. Conclusion: The event trees, when combined with the Utstein template, demonstrated the importance of examining comprehensively datasets for both witnessed and unwitnessed cardiac arrests when monitoring performance standards. The analyses also emphasised the relevance of community programmes in Greater London for teaching basic life saving skills. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.