バイスタンダーによるCPRは生存率向上および神経学的転帰が良好であることと関連がある(Abstract 1189-355)

HeartRescue：バイスタンダーによるCPRおよび除細動は院外心停止後の予後を改善する
HeartRescue: Bystander CPR and defibrillation improves outcomes following out-of-hospital cardiac arrest
院外心停止患者に対するバイスタンダーによる心肺蘇生（CPR）およびファーストレスポンダーによる除細動は、生存率向上および神経学的転帰が良好であることと関連がある、と第65回American College of Cardiology年次集会で発表された。2010～2014年の間に、バイスタンダーによるCPRを施行された患者の割合は自宅および公共の場において有意に増加した一方で、ファーストレスポンダーによる除細動は自宅では増加したが公共の場では増加しなかった。退院時生存率は公共の場における心停止群において10.8%から16.8%に上昇し、自宅における心停止群では5.7%から8.1%に上昇した。神経学的転帰は自宅では改善の傾向がみられ（4.9%から6.1%；p=0.06）、公共の場においては有意に改善した（9.5% から14.7%；p=0.02）。
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Initiatives to improve bystander cardiopulmonary resuscitation (CPR) and first-responder defibrillation may be associated with improved survival and reduced brain injury in people with out-of-hospital cardiac arrest, according to research presented at ACC.16.

Christopher B. Fordyce, M.D., and colleagues at the Duke Clinical Research Institute analyzed 8,269 cases of cardiac arrest between 2010 and 2014 collected from the North Carolina Cardiac Arrest Registry to Enhance Survival. The statewide program, part of the HeartRescue Project, trained family members and bystanders to recognize the signs of sudden cardiac arrest, quickly call emergency responders, and use CPR or automated external defibrillators (AEDs). The study is the first to separately track the effects of such interventions on cardiac arrests in public places and private homes.

Results showed that the proportion of patients receiving bystander CPR increased at home from 28.3 percent to 41.3 percent (p<0.0001) and in public locations from 61.0 percent to 70.6 percent (p=0.007), while first-responder defibrillation increased at home from 42.2 percent to 50.8 percent (p=0.01) but stayed mostly the same in public locations (33.1 percent to 37.8 percent; p=0.16). There was not a statistically significant increase in non-EMS first-responder AED use in public places, which the authors attribute to timely defibrillation by EMS. The rate at which cardiac arrest patients survived until their discharge from the hospital rose from 10.8 to 16.8 percent for public cardiac arrests and from 5.7 to 8.1 percent for cardiac arrests in the home. The rate at which patients only suffered minor losses in brain function or regained it fully increased from 4.9 to 6.1 percent at home and from 9.5 to 14.7 percent in public.

The authors explain that these results are encouraging, but due to the low absolute survival rates, there is still room for improvement. They suggest that future research in this area include interventions such as deploying AEDs into more private homes when cardiac arrests occur and using mobile technology to notify nearby citizens trained in CPR who can initiate care quickly.

"Survival is notoriously worse in private homes, where the majority of cardiac arrests occur," says Fordyce. "Little is known about whether broader efforts to teach people to recognize cardiac arrest and act quickly also impact home cardiac arrests, where the bystander is typically a family member. What's interesting about this study is it's the first time a statewide intervention has improved both public and residential cardiac arrest outcomes," he adds.