Orang terlatih dalam masyarakat (Community first responders, CFR) bagi memberi bantuan kecemasan untuk masalah jantung berhenti di luar hospital pada orang dewasa dan kanak‐kanak
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012764.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 19 julio 2019see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Atención crítica y de emergencia
- Copyright:
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- Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Tomás Barry (TB), Maeve Doheny (MD), Niall Conroy (NC), Siobhán Masterson (SM), Jan Klimas (JK), Ricardo Segurado (RS), Mary Codd (MC), Gerard Bury (GB).
Conceiving the review: TB, GB.
Co‐ordinating the review: TB.
Undertaking manual searches: TB.
Screening search results: TB, MD.
Organizing retrieval of papers: TB, MD.
Screening retrieved papers against inclusion criteria: TB, MD.
Appraising the quality of papers: TB, MD, GB, MC, RS.
Abstracting data from papers: TB, MD, GB.
Writing to authors of papers for additional information: TB.
Providing additional data about papers: TB.
Obtaining and screening data on unpublished studies: TB.
Managing data for the review: TB, MD, NC, SM, JK, GB, MC, RS.
Entering data into Review Manager: TB.
Analysing RevMan statistical data: TB, RS, MC.
Performing other statistical analysis not using RevMan: TB, RS, MC.
Interpreting data: TB, MD, SM, NC, JK, GB, RS, MC.
Making statistical inferences: TB, RS, MC.
Writing the review: TB, MD, SM, NC, JK, RS, MC, GB.
Securing funding for the review: TB.
Performing previous work that was the foundation of the present study: TB, SM, GB.
Serving as guarantor for the review: TB.
Taking responsibility for reading and checking the review before submission: TB.
Sources of support
Internal sources
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No sources of support supplied
External sources
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European Commission Grant (701698), Ireland.
The work of Jan Klimas on this review was funded, in part, by European Commission Grant (701698)
Declarations of interest
Tomas Barry is a general practitioner at the Coombe Family Practice, Dublin, and Assistant Professor at the School of Medicine, University College Dublin, who himself provides voluntary emergency response to out‐of‐hospital cardiac arrest. He declares no conflicts of interest.
Gerard Bury is Professor of General Practice at the School of Medicine, UCD, and a general practitioner in Dublin. Prof Bury declared an interest in a grant pending to the Irish Community Rapid Response (registered charity): "Further development of the GP role as first responder to OHCA". The focus in this project is on the use of alerting technologies. He is a member of a review group for the Health Service Executive, Ireland, developing national KPIs for the statutory ambulance services. He is a member of an expert group for the Medical Advisory Group, Pre‐Hospital Emergency Care Council, for the development of Clinical Practice Guidelines for registered prehospital providers.
Prof Bury declares that his academic roles provide a context for involvement in this research programme but do not create a conflict of interest for him in respect of the aim, methods, or outcomes of this work.
Mary Codd is Associate Professor of Epidemiology and Biostatistics at University College Dublin, and Director of UCD CSTAR (Centre for Support and Training in Analysis and Research). She declares no conflicts of interest.
Jan Klimas is a Post‐doctoral Fellow at University College Dublin, School of Medicine, and at British Columbia Centre on Substance Use, University of British Columbia. His work on this Review was funded, in part, by a grant from the European Commission (701698). His institution was in receipt of the ELEVATE Grant (2014 to 2017): Irish Research Council International Career Development Fellowship, co‐funded by Marie Cure Actions (ELEVATEPD/2014/6).
Niall Conroy is an Assistant Professor at the School of Medicine, University College Dublin. He declares no conflicts of interest.
Siobhan Masterson is the Clinical Lead for Strategy and Evaluation in the Health Service Executive's National Ambulance Service. Dr Masterson is a Research Fellow with the Discipline of General Practice, in National University of Ireland, Galway. She is in receipt of Applied Partnership Award funding from the Health Research Board as a Primary Investigator. She declares no conflicts of interest.
Ricardo Segurado is Associate Professor of Biostatistics, in University College Dublin, and is a consultant with UCD CSTAR. He is a member of a voluntary first aid organization that could be perceived to have an interest in the outcome of this review.
Maeve Doheny is a general practitioner at the Coombe Family Practice, Dublin, and Assistant Professor at the School of Medicine, University College Dublin. She declares no conflicts of interest.
Acknowledgements
We would like to thank Jane Cracknell (Managing Editor, Cochrane Anaesthesia, Critical and Emergency Care Group (ACE)) and all other involved editors for their help and advice in preparing the protocol and review, as well as Diarmuid Stokes (University College Dublin (UCD) Health Sciences Library) and Janne Vendt (Cochrane Information Specialist (ACE)) for their help in preparing the search strategy.
The protocol was screened by the following Cochrane Emergency and Critical Care editors: Bronagh Blackwood, Jane Cracknell, Harald Herkner, Nathan Pace, Janne Vendt, and Cathal Walsh.
We would like to thank Anna Lee (Content Editor) and Andrit Lourens, Sandra M Marini, and Kyle Grant (Peer Reviewers) for their help and editorial advice during preparation of the protocol (Barry 2017).
We would like to thank Anna Lee (Content Editor); Judith Finn and Sandra M Marini (Peer Reviewers); Jonathan M Fuchs (Consumer Referee); and Harald Herkner (Co‐ordinating Editor) for their help and editorial advice during preparation of this systematic review.
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Jul 19 | Community first responders for out‐of‐hospital cardiac arrest in adults and children | Review | Tomas Barry, Maeve C Doheny, Siobhán Masterson, Niall Conroy, Jan Klimas, Ricardo Segurado, Mary Codd, Gerard Bury | |
| 2017 Aug 25 | Community first responders for out‐of‐hospital cardiac arrest | Protocol | Tomas Barry, Niall Conroy, Siobhán Masterson, Jan Klimas, Ricardo Segurado, Mary Codd, Gerard Bury | |
Differences between protocol and review
We made the following changes to the published protocol (Barry 2017).
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We altered the title to refect the population of concern for this review.
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MD joined as a review author and took responsibility for many of the roles previously provisionally assigned to NC.
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We replaced the term 'ambulance service' with 'EMS' (emergency medical services) throughout the review, as EMS is a more internationally recognized term and was the terminology used in the included studies.
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To increase robustness, three review authors (TB, MD, GB), rather than two, independently extracted data and assessed risk of bias related to included studies.
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For the domain of 'incomplete outcome data', we assessed risk of bias at the outcome level rather than at the study level, as the risk of bias was considered to differ by outcome.
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We had planned to use risk ratios with 95% confidence intervals to measure dichotomous outcomes; however the included cluster‐RCT expressed outcomes as odds ratios (ORs) appropriately adjusted for the cluster design effect (van Alem 2003); thus for the purpose of standardization, we expressed dichotomous outcomes as ORs throughout.
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We included all primary outcomes in the 'Summary of findings' table, as per the standard Cochrane protocol. In addition, we included 'cardiopulmonary resuscitation performed before EMS arrival' and 'defibrillation performed before EMS arrival', as these outcomes are of key relevance given the overall review findings. We also included 'survival to hospital admission', as peer review feedback suggested that this would be important to readers.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Humans;
PICO
PRISMA study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| Mobilization of community first responders (CFRs) in addition to routine emergency medical services (EMS) care compared to routine EMS care for out‐of‐hospital cardiac arrest (OHCA) | |||
| Patient or population: adults and children more than 4 weeks old suffering from OHCA | |||
| Outcomes | Impact | № of participants | Certainty of the evidence |
| Survival at hospital discharge | 1 study (a cluster‐RCT) conducted in Amsterdam and surrounding areas considered mobilization of police and fire service CFRs equipped with AEDs. Study authors found no difference in survival at hospital discharge (OR 1.3, 95% CI 0.8 to 2.2) | 469 | ⊕⊕⊝⊝ |
| Survival at 30 days | 1 study (an RCT) undertaken in Stockholm, Sweden, considered mobilization of nearby lay volunteers who were trained to perform CPR. Study authors found no difference in survival at 30 days (OR 1.34, 95% CI 0.79 to 2.29) | 612 | ⊕⊕⊝⊝ |
| Neurological function at hospital discharge, measured by cerebral performance category (CPC) | No data were available | This outcome was not measured | ‐ |
| Neurological function at 30 days, measured by cerebral performance category (CPC) | No data were available | This outcome was not measured | ‐ |
| Cardiopulmonary resuscitation performed before EMS arrival | 1 study (an RCT) undertaken in Stockholm, Sweden, considered mobilization of nearby lay volunteers who were trained to perform CPR. Study authors found an increase in CPR performed before EMS arrival in the intervention group (OR 1.49, 95% CI 1.09 to 2.03) | 665 | ⊕⊕⊕⊝ |
| Defibrillation performed before EMS arrival | 1 study (a cluster‐RCT) conducted in Amsterdam and surrounding areas considered mobilization of police and fire service CFRs equipped with AEDs. Study authors found that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group | 469 | ⊕⊕⊕⊝ |
| Survival to hospital admission | 1 study (a cluster‐RCT) conducted in Amsterdam and surrounding areas considered mobilization of police and fire service CFRs equipped with AEDs. Study authors found increased survival to hospital admission (OR 1.5, 95% CI 1.1 to 2.0) | 469 | ⊕⊕⊕⊝ |
| GRADE Working Group grades of evidence. AED = automatic external defibrillator; CI = confidence interval; CFR = community first responder; CPC = cerebral performance category; CPR = cardiopulmonary resuscitation; EMS = emergency medical services; OHCA = out‐of‐hospital cardiac arrest; OR = odds ratio; RCT = randomized controlled trial. | |||
| aDowngraded two levels for very significant risk of bias (control group may have been exposed to an intervention effect; CPR before EMS arrival). bDowngraded two levels for very significant risk of bias (data missing for 55/667 participants for this outcome; 26% of eligible participants excluded from the trial; study not powered for this outcome). cDowngraded one level for significant risk of bias (26% of eligible participants excluded from the trial). dDowngraded one level for significant risk of bias (risk of both selection and detection bias; this outcome did not represent a primary or secondary outcome in this study). eDowngraded one level for significant risk of bias (control group may have been exposed to an intervention effect ‐ CPR before EMS arrival; however, this would be expected to reduce the chance of finding a difference between control and intervention groups for this outcome; risk of both selection and detection bias for this outcome). | |||
| Intervention | Control | ||
| Included participants | 243 | 226 | |
| Outcome | OR (95% CI) | ||
| Survival at hospital discharge | 44/243 | 33/226 | 1.3 (0.8 to 2.2) |
| Neurological function at hospital discharge, measured by cerebral performance category (CPC) | not reported | ||
| Survival to hospital admission | 103/243 | 74/226 | 1.5 (1.1 to 2.0) |
| CPR performed before EMS arrival | not reported | ||
| Defibrillation performed before EMS arrival | 72/243 | 0/226 | N/A |
| Survival at 30 days | not reported | ||
| Neurological function at 30 days, measured by CPC | not reported | ||
| Health‐related quality of life at 90 days | not reported | ||
| CI = confidence interval; CPC = cerebral performance category; EMS = emergency medical services; N/A =not applicable; OR = odds ratio. | |||
| Intervention | Control | ||
| Included participants | 306 | 361 | |
| Outcome | OR (95% CI)* | ||
| Survival at hospital discharge | not reported | ||
| Neurological function at hospital discharge, measured by cerebral performance category (CPC). | not reported | ||
| Survival to hospital admission | not reported | ||
| CPR performed before EMS arrival | 196/305 | 197/360 | 1.49 (1.09 to 2.03) |
| Defibrillation performed before EMS arrival | not reported | ||
| Survival at 30 days | 32/286 | 28/326 | 1.34 (0.79 to 2.29) |
| Neurological function at 30 days, measured by CPC | not reported | ||
| Health‐related quality of life at 90 days | not reported | ||
| CI = confidence interval; CPC = cerebral performance category; EMS = emergency medical services; OR = odds ratio. *ORs and 95% CIs for this study were calculated by the review authors. | |||
