Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest
Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest
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DOI：
10.1161/circoutcomes.116.003414
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发表时间：
2017-06-01
影响因子：
6.9
通讯作者：
Granger, Christopher B.
中科院分区：
文献类型：
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作者：
Kragholm, Kristian;Hansen, Carolina Malta;Granger, Christopher B.
背景-实践指南建议对院外心脏骤停进行区域性护理。然而，紧急医疗服务是否应该绕过非经皮心脏介入（non-PCI）设施，并将院外心脏骤停患者直接运送到PCI中心，尽管运送时间较长，仍然是未知的。我们发现了院前自主循环恢复的住院心脏骤停患者，并评价直接转运至PCI中心与结局之间的相关性在北卡罗来纳州的一次枪击案根据PCI中心状态对目的地医院进行分类（导管插入实验室可随时访问，24/7）。对年龄、性别、紧急医疗服务响应时间、县的聚集性、到最近的PCI中心的运输时间、初始心律和院前ECG信息进行逆概率加权Logistic回归。在1507例院前自主循环恢复的患者中，1359例（90.2%）被送往PCI中心，其中873例（57.9%）绕过最近的非PCI医院，148例（9.8%）被送往非PCI医院。送往PCI中心的患者出院生存率较高（33.5%比14.6%;调整后的比值比，2.47; 95%置信区间，2.08-2.92）。与送往非PCI医院的患者相比，送往最近的PCI中心医院的患者（优势比，3.07; 95%置信区间，1.90-4.97）和绕过离PCI中心较近的医院的患者（优势比，3.02; 95%置信区间，2.01-4.53）的生存率较高。调整后的生存率在1至5，6至10，11至20，21至30，和>30 minutes. Conclusions的运输时间保持显着更好的直接运输到PCI中心与更好的结果为院外心脏骤停患者，即使绕过最近的医院，无论运输时间。
Background-Practice guidelines recommend regional systems of care for out-of-hospital cardiac arrest. However, whether emergency medical services should bypass nonpercutaneous cardiac intervention (non-PCI) facilities and transport out-of-hospital cardiac arrest patients directly to PCI centers despite longer transport time remains unknown.Methods and Results-Using the Cardiac Arrest Registry to Enhance Survival with geocoding of arrest location, we identified out-of-hospital cardiac arrest patients with prehospital return of spontaneous circulation and evaluated the association between direct transport to a PCI center and outcomes in North Carolina during 2012 to 2014. Destination hospital was classified according to PCI center status (catheterization laboratory immediately accessible 24/7). Inverse probability-weighted logistic regression accounting for age, sex, emergency medical services response time, clustering of county, transport time to nearest PCI center, initial heart rhythm, and prehospital ECG information was performed. Of 1507 patients with prehospital return of spontaneous circulation, 1359 (90.2%) were transported to PCI centers, of whom 873 (57.9%) bypassed the nearest non-PCI hospital and 148 (9.8%) were transported to non-PCI hospitals. Discharge survival was higher among those transported to PCI centers (33.5% versus 14.6%; adjusted odds ratio, 2.47; 95% confidence interval, 2.08-2.92). Compared with patients taken to non-PCI hospitals, odds of survival were higher for patients taken to the nearest hospital with PCI center status (odds ratio, 3.07; 95% confidence interval, 1.90-4.97) and for patients bypassing closer hospitals to PCI centers (odds ratio, 3.02; 95% confidence interval, 2.01-4.53). Adjusted survival remained significantly better across transport times of 1 to 5, 6 to 10, 11 to 20, 21 to 30, and >30 minutes.Conclusions-Direct transport to a PCI center is associated with better outcomes for out-of-hospital cardiac arrest patients, even when bypassing nearest hospital and regardless of transport time.