کارایی یک سیستم جهانی با روش جدید تشخیص درباره ایست قلبی
Abstract
Introduction
Methods
Results
Discussion
Limitations
Conclusion
References
ABSTRACT
Aim: The detection of cardiac arrests by dispatchers allows telephone-assisted cardiopulmonary resuscitation (t-CPR) and improves Out-of-Hospital Cardiac Arrest (OHCA) survival. To enhance the OHCA detection rate, in 2012, the Paris Fire Brigade dispatch center created an original technique called "Hand On Belly" (HoB). The new algorithm that resulted has become a central point in a broader program for dispatch-assisted cardiac arrests. Methods: This is a repeated cross-sectional study with retrospective data of four 15-day call samples recorded from 2012 to 2018. We included all calls from OHCAs cared for by Basic Life Support (BLS) teams and excluded calls where the dispatcher wasn’t in contact directly with a witness. The primary endpoint was the successful detection of an OHCA by the dispatcher; the secondary endpoints were successful t-CPR and measurements of the different time intervals related to the call. Logistic regressions were performed to assess parameters associated with detecting OHCAs and initiating t-CPR. Results: From 2012 to 2018, among the detectable OCHAs, the proportion correctly identified increased from 54% to 93% ; the rate of t-CPRs from 51% to 84%. OHCA detection and tCPR initiation were both associated with HoB breathing assessments (adjustedOR:89, 95%CI:31-299, and adjustedOR:11.2, 95%CI:1.4-149, respectively). Over the study period, the times to answering calls and the time to sending BLS teams were shorter than those recommended by international guidelines; however, the times to OHCA recognition and starting t-CPR delivery were longer. Conclusions: The HoB effectively facilitated OHCA detection in our system, which has achieved very high performance levels.
Introduction
During an out-of-hospital cardiac arrest (OHCA), each link in the survival chain has an impact on the patient's outcome and allow one to continue to the next link until survival is achieved. The first link, "early recognition of OHCA", is probably the most crucial. In France, the incidence of OHCAs is about 50/100,000 inhabitants/year. Although 30-40% of the population has received at least one training session in first aid, less than 10% of bystanders recognize OHCAs prior to the call for help. In the literature, dispatcher-assisted cardio-pulmonary resuscitation (DA-CPR) combines cardiac arrest (CA) detection and telephone-assisted cardio-pulmonary resuscitation (t-CPR). It increases the OHCA detection rate and the likeliness that chest compressions (CC) will be performed by bystanders until the arrival of the basic life support team (BLS). Indeed, bystander, whatever his level of first aid knowledge, can limit the time spent without no-flow and reduce OHCA mortality.