■回顾和总结现有的文献和知识差距,这些文献和知识差距已经过测试,以优化院外心脏骤停(OHCA)的调度员辅助CPR(DA-CPR)指导协议。
本范围审查由国际复苏联络委员会(ILCOR)基本生命支持范围审查小组进行,并在ILCOR方法框架和系统审查和Meta分析扩展范围审查的首选报告项目(PRISMA-ScR)的指导下进行。如果研究发表在同行评审的期刊上,并评估了用于改善DA-CPR的干预措施,则有资格纳入研究。搜索是在MEDLINE进行的,EMBASE,教育资源信息中心(ERIC),PsycINFO,Cochrane图书馆,循证医学(EBM)评论,和坎贝尔图书馆从2000年到2023年12月18日。
■经过全文回顾,最终审查中包括31项研究。审查的干预措施是在现场使用视频(n=9),关于压缩的术语的变化(n=6),新型DA-CPR方案的实施(n=4),高级调度员培训(n=3),调度中心的集中化(n=2),使用节拍器或不同的节拍器速率(n=2),CPR序列和压缩比的变化(n=1),动画视听录音(n=1),预先记录的说明与会话实时指令(n=1),纳入“患者脱衣服”说明(n=1),和具体的言语鼓励(n=1)。研究的方法学范围从注册研究到随机临床试验,其中大多数是模拟EMS调用OHCA的观察性研究。结果变化很大,但包括旁观者心肺复苏率,信心和意愿进行心肺复苏,开始旁观者心肺复苏的时间,旁观者CPR质量(包括CPR指标:胸部按压深度和速率;胸部按压分数;全胸部后坐力,通气率,整体CPR能力),自动体外除颤器(AED)使用率,恢复自主循环(ROSC)和生存。总的来说,所有干预措施似乎都与旁观者CPR和CPR指标的潜在改善相关.
■关键结果似乎有改进的趋势,但需要更多的研究。本范围审查强调了缺乏对任何经过测试的干预措施的高质量临床研究,以改善DA-CPR。没有足够的证据通过系统评价来探索这些干预措施的有效性。
UNASSIGNED: To review and summarize existing literature and knowledge gaps regarding interventions that have been tested to optimize dispatcher-assisted CPR (DA-CPR) instruction protocols for out-of-hospital cardiac arrest (OHCA).
UNASSIGNED: This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were published in peer-reviewed journals and evaluated interventions used to improve DA-CPR. The search was carried out in MEDLINE, EMBASE, Education Resources Information Center (ERIC), PsycINFO, the Cochrane Library, Evidence Based Medicine (EBM) Reviews, and the Campbell Library from 2000 to December 18, 2023.
UNASSIGNED: After full text review, 31 studies were included in the final review. The interventions reviewed were use of
video at the scene (n = 9), changes in terminology about compressions (n = 6), implementation of novel DA-CPR protocols (n = 4), advanced dispatcher training (n = 3), centralization of the dispatch center (n = 2), use of metronome or varied metronome rates (n = 2), change in CPR sequence and compression ratio (n = 1), animated audio-visual recording (n = 1), pre-recorded instructions vs. conversational live instructions (n = 1), inclusion of \"undress patient\" instructions (n = 1), and specific verbal encouragement (n = 1). Studies ranged in methodology from registry studies to randomized clinical trials with the majority being observational studies of simulated EMS calls for OHCA. Outcomes were highly variable but included rates of bystander CPR, confidence & willingness to perform CPR, time to initiation of bystander CPR, bystander CPR quality (including CPR metrics: chest compression depth and rate; chest compression fraction; full chest recoil, ventilation rate, overall CPR competency), rates of automated external defibrillator (AED) use, return of spontaneous circulation (ROSC) and survival. Overall, all interventions seem to be associated with potential improvement in bystander CPR and CPR metrics.
UNASSIGNED: There appears to be trends towards improvement on key outcomes however more research is needed. This scoping review highlights the lack of high-quality clinical research on any of the tested interventions to improve DA-CPR. There is insufficient evidence to explore the effectiveness of any of these interventions via systematic review.