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論文 |
論文
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Tanaka, Yoshio ; Maeda, Tetsuo ; Kamikura, Takahisa ; Nishi, Taiki ; Omi, Wataru ; Hashimoto, Masaaki ; Sakagami, Satoru ; Inaba , Hideo
概要:
Aim: To investigate whether the bystander-patient relationship affects bystander response to out-of-hospital cardiac arr
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est (OHCA) and patient outcomes depending on the time of day. Methods: This population-based observational study in Japan involving 139,265 bystander-witnessed OHCAs (90,426 family members, 10,479 friends/colleagues, and 38,360 others) without prehospital physician involvement was conducted from 2005 to 2009. Factors associated with better bystander response [early emergency call and bystander cardiopulmonary resuscitation (BCPR)] and 1-month neurologically favourable survival were assessed. Results: The rates of dispatcher-assisted CPR during daytime (7:00-18:59) and nighttime (19:00-6:59) were highest in family members (45.6% and 46.1%, respectively, for family members; 28.7% and 29.2%, respectively, for friends/colleagues; and 28.1% and 25.3%, respectively, for others). However, the BCPR rates were lowest in family members (35.5% and 37.8%, respectively, for family members; 43.7% and 37.8%, respectively, for friends/colleagues; and 59.3% and 50.0%, respectively, for others). Large delays (≥5. min) in placing emergency calls and initiating BCPR were most frequent in family members. The overall survival rate was lowest (2.7%) for family members and highest (9.1%) for friends/colleagues during daytime. Logistic regression analysis revealed that the effect of bystander relationship on survival was significant only during daytime [adjusted odds ratios (95% CI) for survival from daytime OHCAs with family as reference were 1.51 (1.36-1.68) for friends/colleagues and 1.23 (1.13-1.34) for others]. Conclusions: Family members are least likely to perform BCPR and OHCAs witnessed by family members are least likely to survive during daytime. Different strategies are required for family-witnessed OHCAs.
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| 2.
論文 |
論文
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Takei, Yutaka ; Nishi, Taiki ; Matsubara, Hiroki ; Hashimoto, Masaaki ; Inaba, Hideo
概要:
Aims: To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR). Methods: Data
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were prospectively collected from 553 out-of-hospital cardiac arrests (OHCAs) managed with BCPR in the absence of emergency medical technicians (EMT) during 2012. The quality of BCPR was evaluated by EMTs at the scene and was assessed according to the standard recommendations for chest compressions, including proper hand positions, rates and depths. Results: Good-quality BCPR was more frequently confirmed in OHCAs that occurred in the central/urban region (56.3% [251/446] vs. 39.3% [42/107], p= 0.0015), had multiple rescuers (31.8% [142/446] vs. 11.2% [12/107], p< 0.0001) and received bystander-initiated BCPR (22.0% [98/446] vs. 5.6% [6/107], p< 0.0001). Good-quality BCPR was less frequently performed by family members (46.9% [209/446] vs. 67.3% [72/107], p= 0.0001), elderly bystanders (13.5% [60/446] vs. 28.0% [30/107], p= 0.0005) and in at-home OHCAs (51.1% [228/446] vs. 72.9% [78/107], p< 0.0001). BCPR duration was significantly longer in the good-quality group (median, 8 vs. 6. min, p= 0.0015). Multiple logistic regression analysis indicated that multiple rescuers (odds ratio. = 2.8, 95% CI 1.5-5.6), bystander-initiated BCPR (2.7, 1.1-7.3), non-elderly bystanders (1.9, 1.1-3.2), occurrence in the central region (2.1, 1.3-3.3) and duration of BCPR (1.1, 1.0-1.1) were associated with good-quality BCPR. Moreover, good-quality BCPR was initiated earlier after recognition/witness of cardiac arrest compared with poor-quality BCPR (3 vs. 4. min, p= 0.0052). The rate of neurologically favourable survival at one year was 2.7 and 0% in the good-quality and poor-quality groups, respectively (p= 0.1357). Conclusions: The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR. © 2013 Elsevier Ireland Ltd.
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