摘要
背景:行心肺复苏术(CPR)时,口对口人工呼吸对于旁观者来说比较困难,但少有临床研究观察了旁观者采用胸部按压而不行口对口人工呼吸进行复苏(单纯心脏复苏)的效果。方法:对院外心脏停搏患者进行了一项前瞻性、多中心观察研究。到达现场后,医务人员评估旁观者的复苏技术。主要终点为心脏停搏后30d的良好神经系统预后。结果:4068例经旁观者目击发生院外心脏停搏的成年患者被纳入本研究;
Background: Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation(CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation(cardiac-only resuscitation). Methods: We did a prospective, multicentre, observational study of patients who had out-of-hospital cardiac arrest. On arrival at the scene, paramedics assessed the technique of bystander resuscitation. The primary endpoint was favourable neurological outcome 30 days after cardiac arrest. Findings: 4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439(11% ) received cardiac-only resuscitation from bystanders, 712(18% ) conventional CPR, and 2917(72% ) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favourable neurological outcomes than no resuscitation(5.0% vs 2.2% , p< 0.0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favourable neurological outcomes than conventional CPR in patients with apnoea(6.2% vs 3.1% ; p=0.0195), with shockable rhythm(19.4% vs 11.2% , p=0.041), and with resuscitation that started within 4 min of arrest(10.1% vs 5.1% , p=0.0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favourable neurological outcome after cardiac-only resuscitation was 2.2(95% CI 1.2- 4.2) in patients who received any resuscitation from bystanders. Interpretation: Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.
