资源有限地区院外心脏骤停管理的卫生系统准备情况：巴基斯坦信德省农村和郊区的混合方法研究

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中文摘要

背景： 院外心脏骤停需要强有力的应急响应系统才能提高生存率。在巴基斯坦信德省郊区和农村等资源匮乏地区，人们对医疗系统和社区的准备情况知之甚少。
目的： 本研究旨在通过研究这些地区生存链的院外和院内环节，全面评估巴基斯坦信德省农村和郊区院外心脏骤停管理的系统准备情况。
方法： 采用三角互证混合方法设计。研究在巴基斯坦信德省北部、中部和南部郊区及农村地区的七家医院开展。使用患者满意度问卷-18进行退出访谈（n=163）以及设施准备情况清单（n=7家医院）获得的定量数据采用描述性统计进行分析。定性数据通过社区成员和救护车人员的焦点小组讨论、急诊室医生和护士的深度访谈以及急诊室主管和心脏病专家的关键知情人访谈收集，并采用主题分析进行分析。
结果： 对163名患者的退出访谈显示，满意度最低的比例分别为沟通（26.4%）、财务方面（31.3%）、可及性和便利性（32.5%）、急诊室人员的技术质量（40.5%）以及与医生相处的时间（47.2%）。在评估的七家设施中，两家配备除颤器，但均无法正常工作；四家配备肾上腺素，三家配备脉搏血氧仪，三家配备气管内导管，而所有设施均没有喉罩气道。来自12次焦点小组讨论、15次深度访谈和3次关键知情人访谈的定性数据识别出对心脏骤停识别有限、救护车可用性不足、道路通行条件差、训练有素的工作人员和复苏设备短缺、社会文化和性别相关障碍，以及急诊护理治理和数据系统薄弱等问题。
结论： 定量和定性研究结果的三角互证显示，信德省农村和郊区的生存链在多个环节薄弱，包括社区、院前护理、卫生设施和治理。该研究表明需要在多个层面加强系统，包括对社区成员、救护车人员和急诊室工作人员进行心肺复苏培训，制定复苏准备的最低标准，并建立院外心脏骤停登记系统。

英文摘要

BACKGROUND: Out-of-hospital-cardiac-arrest requires a robust emergency response system for survival. In low-resource settings like suburban and rural Sindh in Pakistan, little is known about the readiness of healthcare systems and communities.
AIM: The aim of this study was to comprehensively assess the system-readiness for out-of-hospital-cardiac-arrest management in rural and suburban areas of Sindh, Pakistan by studying out-of-hospital and in-hospital elements of chain of survival in these areas.
METHODS: A triangulation mixed-methods design was used. The study was conducted in seven hospitals in the suburban and rural areas of upper, central and southern parts of the province of Sindh, Pakistan. Quantitative data from exit interviews (n = 163) using the Patient Satisfaction Questionnaire-18 and a facility readiness checklist (n = 7 hospitals) were analysed using descriptive statistics. Qualitative data were collected through focus group discussions with community members and ambulance crew, in-depth interviews with emergency room doctors and nurses, and key informant interviews with emergency room supervisors and cardiologists and were analysed using thematic analysis.
RESULTS: Exit interviews with 163 patients showed that the lowest proportions satisfied were for communication (26.4%), financial aspects (31.3%), accessibility and convenience (32.5%), technical quality of emergency room staff (40.5%), and time spent with doctors (47.2%). Among the seven facilities assessed, defibrillators were available in two, but neither was functional; epinephrine was available in four, pulse oximeters in three, and endotracheal tubes in three, while laryngeal mask airways were unavailable in all facilities. Qualitative data from 12 focus group discussions, 15 in-depth interviews, and three key informant interviews identified limited recognition of cardiac arrest, inadequate ambulance availability, poor road access, shortages of trained staff and resuscitation equipment, sociocultural and gender-related barriers, and weaknesses in emergency care governance and data systems.
CONCLUSION: Triangulation of quantitative and qualitative findings showed that the Chain of Survival in rural and suburban Sindh is weak at several points, including the community, prehospital care, health facilities, and governance.The study shows that there is a need to strengthen the system at multiple levels. This includes training community members, ambulance crew and emergency room staff in cardiopulmonary resuscitation, setting minimum standards for resuscitation readiness, and creating out-of-hospital-cardiac-arrest registries.