目的:院外心脏骤停(OHCA)与适当提供公共除颤(PAD)之间的关系尚不清楚。本研究旨在评估与是否提供PAD相关的因素。
方法:这项回顾性队列研究利用了2021年全日本Utstein和紧急交通登记处的数据。我们包括OHCA患者,这些患者被旁观者应用于自动体外除颤器(AED),并被AED认为有资格进行除颤。我们根据旁观者除颤定义了提供PAD或不提供PAD。采用Firth偏差调整方法进行多变量逻辑回归分析,以估计调整后的优势比(AORs)和95%置信区间(CIs),以探索性评估与PAD相关的因素。
结果:1949例患者符合分析条件(提供PAD,n=1696[87.0%];未提供PAD,n=253[13.0%])。与PAD呈正相关的因素是男性(AOR[95%CI],1.61[1.17-2.21];vs.female),其他公共场所发病率(AOR[95%CI],10.65[1.40-1367.54];vs.公共场所),非家庭成员见证(AOR[95%CI],2.51[1.86-3.42];vs.无人见证)和常规心肺复苏(CPR),(AOR[95%CI],1.75[1.17-2.67];vs.仅手CPR)。相反,与无PAD呈负相关的因素是65岁以上(AOR[95%CI],0.48[0.28-0.80];vs.19-64年),夜间发作(AOR[95%CI],0.61[0.45-0.83];vs.白天),非心源性(AOR[95%CI],0.43[0.31-0.61];vs.心源性),家庭设置(AOR[95%CI],0.33[0.14-0.83];vs.公共场所),医疗机构设置(AOR[95%CI],0.40[0.23-0.66];vs.公共场所),无旁观者心肺复苏术(AOR[95%CI],0.31[0.14-0.71];vs.仅手CPR),和调度员协助(AOR[95%CI],0.72[0.53-0.97];vs.没有调度员协助)。
结论:男性患者,其他公共场所发作,由非家庭和常规CPR见证与PAD提供相关。因此,培训熟练的急救人员适当使用AED是必要的。
OBJECTIVE: The association between out-of-hospital cardiac arrest (OHCA) and the appropriate provision of public access defibrillation (PAD) remains unclear. This study aimed to evaluate the factors associated with the factors associated with whether or not PAD was provided.
METHODS: This retrospective cohort study utilized the All-Japan Utstein and Emergency Transport Registries data in 2021. We included OHCA patients who were applied to automated external defibrillators (AEDs) by bystanders and were deemed eligible for defibrillation by an AED. We defined PAD provided or no PAD provided based on bystander defibrillation. Multivariable logistic regression analysis with the Firth bias adjustment method was employed to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the exploratory evaluation of factors associated with PAD provided.
RESULTS: 1949 patients were eligible for analysis (PAD provided, n = 1696 [87.0%]; no PAD provided, n = 253 [13.0%]). Factors positively associated with PAD provided were male (AOR [95% CI], 1.61 [1.17-2.21]; vs. female), other public place incidence (AOR [95% CI], 10.65 [1.40-1367.54]; vs. public place), non-family member witnessed (AOR [95% CI], 2.51 [1.86-3.42]; vs. unwitnessed) and conventional cardiopulmonary resuscitation (CPR), (AOR [95% CI], 1.75 [1.17-2.67]; vs. hands-only CPR). Conversely, factors negatively associated with no PAD provided were over 65 years old (AOR [95% CI], 0.48 [0.28-0.80]; vs. 19-64 yr), night-time onset (AOR [95% CI], 0.61 [0.45-0.83]; vs. daytime), non-cardiogenic (AOR [95% CI], 0.43 [0.31-0.61]; vs. cardiogenic), home setting (AOR [95% CI], 0.33 [0.14-0.83]; vs. public place), healthcare facility setting (AOR [95% CI], 0.40 [0.23-0.66]; vs. public place), no bystander CPR (AOR [95% CI], 0.31 [0.14-0.71]; vs. hands-only CPR), and dispatcher-assistance (AOR [95% CI], 0.72 [0.53-0.97]; vs. no dispatcher-assistance).
CONCLUSIONS: Male patients, other public place onset, witnessed by non-family and conventional CPR were associated with PAD provide. Therefore, training skilled first responders to use AEDs appropriately is necessary.