| Summary: | 碩士 === 國立陽明大學 === 急重症醫學研究所 === 98 === Background: Cardiopulmonary resuscitation (CPR) guidelines have been revised in 2005 based on new evidence and expert consensus. However, the benefits of the new guidelines remain undetermined and their influence has not been published in Asia. This study aimed to evaluate the impact of implementing the new resuscitation guidelines and identify factors that influence discharge survival of out-of-hospital cardiac arrest (OHCA) patients in an Asia metropolitan city.
Methods: This was an observational cohort study of all OHCA patients seen by the emergency medical service during period before (Nov 2003-Oct 2005) and after (May 2006-Oct 2008) implementing the new resuscitation guidelines. Detailed clinical information was recorded using the Ustein style template. Statistical analysis was done using X2 test or t-test for univariate analysis and logistic regression model for multivariate analysis.
Results: There were 463 patients before and 430 patients after the new guidelines who received resuscitation. The rate of recovery of spontaneous circulation (ROSC), survival-to-intensive care unit (ICU) admission, and survival-to-hospital discharge all showed no benefits regarding the new resuscitation guidelines (ROSC: 42% v.s 39%, p=0.32; Survival-to-ICU admission: 33% v.s. 30%, p=0.27; survival-to-hospital discharge: 10% v.s.7%, p=0.09). The rate of ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT), rate of witnessed arrest, and rate of bystander CPR were much lower than in Western studies. After multivariate logistic regression, factors related to discharge survival were witnessed arrest and initial rhythm with VF/pulseless VT. The new resuscitation guidelines did not significantly influence the discharge survival.
Conclusions: We did not observe any improvement in survival after implementing the new guidelines. Independent factors of survival-to-hospital discharge are witnessed arrest and initial rhythm with VF/pulseless VT. Because the rates of VF/pulseless VT and bystander CPR in Asia are low, popularizing CPR training programs and increasing the rate of bystander CPR may be more important for improving OHCA survival rates than frequent guideline changes.
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