Abstract 266:Impact of bystander-patient relationship on neurological outcome in witnessed elderly patients with out-of-hospital cardiac arrest according to age: a nationwide population-based observational study
Abstract 266:Impact of bystander-patient relationship on neurological outcome in witnessed elderly patients with out-of-hospital cardiac arrest according to age: a nationwide population-based observational study
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摘要 266：旁观者与患者关系对目击老年院外心脏骤停患者神经系统结局的影响（按年龄）：一项全国性的基于人群的观察性研究
DOI：
10.1161/circ.146.suppl_1.266
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发表时间：
2022
期刊：
影响因子：
37.8
通讯作者：
Masayuki Takamura
中科院分区：
文献类型：
--
作者：
Akira Funada;Yoshikazu Goto;Masayuki Takamura
Introduction：由家属见证的院外心脏骤停（OHCA）老年患者的神经系统结局比由非家属旁观者见证的患者更差。Hypothesis：旁观者-患者关系（家属或非家属旁观者）对见证老年OHCA患者神经系统结局的影响可能因年龄而异。数据来自2011年至2016年前瞻性记录的全日本Utstein式登记研究。主要结局是1个月神经功能完整生存率，定义为脑功能分类（CPC）评分为1或2。患者按年龄分为三组（65-74岁、75-89岁和≥ 90岁）。结果：由非家庭旁观者见证的患者1个月CPC 1-2的发生率和旁观者启动的心肺复苏（BCPR）频率[27.4%（1，360/4，971）和68.5%（3，407/4，971）]显著高于由家庭成员见证的患者[19.7%（1，736/8，802）和44.8%（3，942/8，802）]（p < 0.001）。年龄在65-74岁、75-89岁和≥ 90岁的患者中，1个月CPC 1-2的发生率随着年龄的增长而下降，分别为36.2%（1，733/4，788）、16.9%（1，264/7，469）和6.5%（99/1，516）（趋势p < 0.001）。在65-74岁的患者中，由非家庭旁观者见证的患者1个月CPC 1-2的发生率显著高于由家庭成员见证的患者（45.0%和30.9%）和75-89岁（20.2%和15.3%）（分别为p < 0.001），但在≥ 90岁的患者中没有（6.4%和6.7%，p = 0.83）。在多变量logistic回归分析中，调整了性别、初始心律和从接到电话到ROSC的时间，非家庭旁观者的见证和BCPR与65-74岁患者的1个月CPC 1-2显著相关（调整后的比值比分别为1.37和1.44; 95%可信区间分别为1.19-1.58和1.26-1.66），但在75-89岁和≥ 90岁的人群中没有发现。旁观者-患者关系对有目击者的老年OHCA患者神经系统结局的影响随年龄而变化。
Introduction:Elderly patients with out-of-hospital cardiac arrest (OHCA) witnessed by a family member were associated with worse neurological outcome than those witnessed by a non-family bystander.Hypothesis:Impact of bystander-patient relationship (family member or non-family bystander) on neurological outcome in witnessed elderly OHCA patients could differ based on age.Methods:We evaluated 13,773 bystander-witnessed elderly OHCA patients (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein-style Registry between 2011 and 2016. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1 or 2. Patients were divided into three groups by age (65-74, 75-89, and ≥ 90 years).Results:The rates of 1-month CPC 1-2 and the frequencies of bystander-initiated cardiopulmonary resuscitation (BCPR) were significantly higher in patients witnessed by a non-family bystander [27.4% (1,360/4,971) and 68.5% (3,407/4,971)] than in those witnessed by a family member [19.7% (1,736/8,802) and 44.8% (3,942/8,802)] (p < 0.001, respectively). The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years decreased with advancing age, 36.2% (1,733/4,788), 16.9% (1,264/7,469), and 6.5% (99/1,516), respectively (p for trend < 0.001). The rates of 1-month CPC 1-2 were significantly higher in patients witnessed by a non-family bystander than in those witnessed by a family member in those aged 65-74 years (45.0% and 30.9%) and 75-89 years (20.2% and 15.3%) (p < 0.001, respectively), but not in those aged ≥ 90 years (6.4% and 6.7%, p = 0.83). In multivariate logistic regression analysis adjusted for sex, initial rhythm, and time from call receipt to ROSC, witness by a non-family bystander and BCPR were significantly associated with 1-month CPC 1-2 for patients aged 65-74 years (adjusted odds ratio: 1.37 and 1.44, respectively; 95% confidence interval: 1.19-1.58 and 1.26-1.66, respectively), but not in those aged 75-89 and ≥ 90 years.Conclusions:Impact of bystander-patient relationship on neurological outcome in witnessed elderly OHCA patients varied with age.