Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting
Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting
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DOI：
10.1136/hrt.76.1.18
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发表时间：
1996-07-01
期刊：
影响因子：
5.7
通讯作者：
Maatta, T
中科院分区：
文献类型：
--
作者：
Kuisma, M;Maatta, T
目的：了解院外心脏骤停和复苏后存活的流行病学，并将Utstein报告风格应用于数据收集。设计-前瞻性队列研究。设置：中等规模城市（人口51.6万人），实行单一应急医疗服务体系。病人：1994年1月1日至12月31日期间连续发生院前心脏骤停。介入-根据美国心脏协会的建议进行高级心脏生命支持。主要结局指标——从心脏骤停到出院的生存率，以及与生存率相关的因素。结果：有112例患者考虑复苏。院外心脏骤停的总发病率为79.8/10万居民/年。57例（16.6%）存活至复苏出院。32.5%的患者在旁观者目睹心脏骤停并以心室颤动为初始心律时存活。当第一节律为无搏动或无脉性电活动时，放电率分别为6.2%和2.7%。66.5%的旁观者心脏骤停的原因是心脏，65.0%的旁观者心脏源性骤停的原因是心室颤动。22.1%的患者接受了旁观者心肺复苏。从接到电话到第一反应高级生命支持单元和移动重症监护单元到达患者身边以及自然循环恢复的平均时间间隔分别为7.0和10.3 min和12.6和16.7 min。在logistic回归模型中，旁观者目睹的骤停、年龄、作为初始节律的心室颤动和第一反应单元的呼叫到到达间隔是与生存相关的独立因素。研究发现，在该紧急医疗服务系统中，修改时间零点的Utstein式报告是一种合适的数据收集形式。结论：1980年代急诊医疗服务制度实施后发生重大变化。院外心脏骤停明显增加。然而，作为生存之链中最薄弱的环节，抢先体验在不久的将来应该受到重视。发现带有修改时间零的Utstein风格报告是适合的数据收集协议，尽管这很费力。
Objective-To determine the epidemiology of out-of-hospital cardiac arrests and survival after resuscitation and to apply the Utstein style of reporting to data collection.Design-Prospective cohort study.Setting-A middle-sized urban city (population 516 000) served by a single emergency medical services system.Patients-Consecutive prehospital cardiac arrests occurring between 1 January and 31 December 1994.Intervention-Advanced cardiac life support according to the recommendations of American Heart Association.Main outcome measures-Survival from cardiac arrest to hospital discharge, and factors associated with survival.Results-Four hundred and twelve patients were considered for resuscitation. The overall incidence of out-of-hospital cardiac arrest was 79.8/100 000 inhabitants/year. Fifty seven patients (16.6%) survived to discharge when resuscitation was attempted. 32.5% survived when cardiac arrest was bystander witnessed and was of cardiac origin with ventricular fibrillation as the initial rhythm. When asystole or pulseless electrical activity was the first rhythm recorded, discharge rates were 6.2 and 2.7% respectively. The cause of cardiac arrest was cardiac in 66.5%, and ventricular fibrillation was the initial rhythm in 65.0% of bystander witnessed cardiac arrests of cardiac origin. 22.1% of patients received bystander initiated cardiopulmonary resuscitation. The mean time intervals from the receipt of the call to the arrival of a first response advanced life support unit and mobile intensive care unit at the patient's side and to the return of spontaneous circulation were 7.0 and 10.3 and 12.6 and 16.7 min respectively. In the logistic regression model bystander witnessed arrest, age, ventricular fibrillation as initial rhythm, and the call-to-arrival interval of the first response unit were independent factors relating to survival. Utstein style reporting with modification of time zero was found to be an appropriate form of data collection in this emergency medical services system.Conclusions-After implementation of major changes in the emergency medical services system during the 1980s survival. from out-of-hospital cardiac arrest markedly increased. However, early access, which has turned out to be the weakest link in the chain of survival, should receive major attention in the near future. Utstein style reporting with a modified time zero was found to be appropriate, although laborious, protocol for data collection.