Continuous Improvements in "Chain of Survival" Increased Survival After Out-of-Hospital Cardiac Arrests A Large-Scale Population-Based Study
Continuous Improvements in "Chain of Survival" Increased Survival After Out-of-Hospital Cardiac Arrests A Large-Scale Population-Based Study
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DOI：
10.1161/circulationaha.108.802058
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发表时间：
2009-02-10
期刊：
影响因子：
37.8
通讯作者：
Kawamura, Takashi
中科院分区：
文献类型：
--
作者：
Iwami, Taku;Nichol, Graham;Kawamura, Takashi
背景--目前正在努力改善院外心脏骤停的“生存链”的影响尚不清楚。这项研究的目的是评估院前急救的变化对OHCA后存活率的递增影响。方法和结果：这项基于人群的前瞻性观察性研究涉及1998年5月至2006年12月期间连续的OtA患者。主要的结果衡量标准是1个月的存活期和良好的神经学结果。多因素Logistic回归分析被用来评估可能与较好的神经预后相关的因素。在42873例试图复苏的成人OHCA中，8782例旁观者目击的疑似心脏起源的心跳骤停被分析。从昏迷到求医、第一次心肺复苏和首次休克的中位时间分别从4分钟(四分位数范围2~11)缩短到2分钟(IQR 1~5)，从9分钟(IQR 5~13)缩短到7分钟(IQR 3~11)，从19分钟(IQR 13~22)缩短到9分钟(IQR 7~12)。神经学上完好的室颤后1个月存活率从6%(6/96)增加到16%(49/297；P<；0.001)。在所有OHCA中，较早的心肺复苏(每分钟优势比0.89，95%可信区间0.85~0.93)和较早插管(每分钟优势比0.96，95%可信区间0.94~0.99)与较好的神经预后相关。对于室颤，只有较早的休克与较好的预后相关(优势比0.84，95%可信区间0.80至0.88)。结论--来自大规模人群队列的数据显示，随着生存链的改善，uchA存活率持续增加。此外，还建议早期高级护理可增加肝细胞癌的存活率。(发行量。2009年；119：728-734。)
Background-The impact of ongoing efforts to improve the "chain of survival" for out-of-hospital cardiac arrest (OHCA) is unclear. The objective of this study was to evaluate the incremental effect of changes in prehospital emergency care on survival after OHCA.Methods and Results-This prospective, population-based observational study involved consecutive patients with OHCA from May 1998 through December 2006. The primary outcome measure was 1-month survival with favorable neurological outcome. Multiple logistic regression analysis was used to assess factors that were potentially associated with better neurological outcome. Among 42 873 resuscitation-attempted adult OHCAs, 8782 bystander-witnessed arrests of presumed cardiac origin were analyzed. The median time interval from collapse to call for medical help, first cardiopulmonary resuscitation, and first shock shortened from 4 (interquartile range [IQR] 2 to 11) to 2 (IQR 1 to 5) minutes, from 9 (IQR 5 to 13) to 7 (IQR 3 to 11) minutes, and from 19 (IQR 13 to 22) to 9 (IQR 7 to 12) minutes, respectively. Neurologically intact 1-month survival after witnessed ventricular fibrillation increased from 6% (6/96) to 16% (49/297; P < 0.001). Among all witnessed OHCAs, earlier cardiopulmonary resuscitation (odds ratio per minute 0.89, 95% confidence interval 0.85 to 0.93) and earlier intubation (odds ratio per minute 0.96, 95% confidence interval 0.94 to 0.99) were associated with better neurological outcome. For ventricular fibrillation, only earlier shock was associated with better outcome (odds ratio 0.84, 95% confidence interval 0.80 to 0.88).Conclusions-Data from a large, population-based cohort demonstrate a continuous increase in OHCA survival with improvement in the chain of survival. The incremental benefit of early advanced care on OHCA survival is also suggested. (Circulation. 2009; 119: 728-734.)