Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest:: change in outcome over 20 years in the community of Goteborg, Sweden
Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest:: change in outcome over 20 years in the community of Goteborg, Sweden
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DOI：
10.1136/heart.89.1.25
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发表时间：
2003-01-01
期刊：
影响因子：
5.7
通讯作者：
Waagstein, L
中科院分区：
文献类型：
--
作者：
Herlitz, J;Bång, A;Waagstein, L
目的：描述20年期间发生院外心脏骤停并住院存活的患者的生存率变化和与生存相关的因素。患者：包括1980年10月1日至2000年10月1日期间发生院外心脏骤停后在哥德堡社区住院的所有患者。患者数据与复苏时的因素相关，前瞻性地进行计算机处理。对病史和住院资料进行回顾性记录，患者分为两组（第一和第二个10年期）。其中13例10例（24%）存活。第一部分的存活率（活着出院）为37.5%，第二部分（NS）为35.1%。以下是生存率增加的独立预测因素：室颤/心动过速为首次记录的心律（比值比（OR）3.46，95%置信区间（0）2.36至5.07）;目击逮捕（OR 2.50，95% CI 1.52至4.10）;旁观者启动心肺复苏（OR 2.00，95% CI 1.42 - 2.80）;患者入院时意识清醒（OR 6.43，95% CI 3.61 - 11.45）;入院时窦性心律（OR 1.53，95% CI 1.12 - 2.10）;急诊科利多卡因治疗（OR 1.64，95% CI 1.16 - 2.31）。以下是生存率低的独立预测因素：年龄> 70岁（中位数）（OR 0.65，95% CI 0.47至0.88）;急诊科需要阿托品（OR 0.35，95%CI 0.15 - 0.75）;入院前长期使用利尿剂治疗结论：在20年的时间里，在院外心脏骤停的最初幸存者中，随着时间的推移，生存率没有改善。生存率增加的主要指标是初始室颤/心动过速、旁观者心肺复苏、目睹心脏骤停和患者入院时意识清醒。发生率较低的主要指标是年龄较大，急诊科需要阿托品，心脏骤停前长期使用利尿剂治疗。
Objective: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive.Patients: All patients hospitalised clive in the community of Goteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included.Methods: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded, Patients were divided into two groups (the first and second 10 year periods).Setting: Community of Goteborg, Sweden.Results: 5505 patients suffered from) cardiac arrest during the time of the survey. Among them 13 10 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (0) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% Cl 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% Cl 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% Cl 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% Cl 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% Cl 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% Cl 0.47 to 0,88); atropine required in the emergency department (OR 0,35, 95% Cl 0.15 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0,59, 95% Cl 0.43 to 0.81).Conclusion: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine is the emergency department, and chronic treatment with diuretics before cardiac arrest.