Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements
Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements
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DOI：
10.1016/j.annemergmed.2009.09.018
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发表时间：
2010-03-01
影响因子：
6.2
通讯作者：
Nichol, Graham
中科院分区：
文献类型：
--
作者：
Rea, Thomas D.;Cook, Andrea J.;Nichol, Graham
研究目的：院外心脏骤停后的生存取决于生存链中的各个环节。Utstein要素旨在评估这些联系，并为比较社区内和社区间的结果提供基础。我们评估这些措施是否足以预测存活率并解释预后差异。方法：我们使用了从2005年12月1日至2007年3月1日的多点、基于人群的复苏结果联盟Epistry-心脏骤停的观察性、前瞻性数据收集，病例系列为成人非创伤性院外心脏骤停。我们使用Logistic回归、受试者操作曲线和方差测量来估计Utstein因素预测出院前存活的程度，并解释总体和7个复苏结果联盟站点之间的结果差异。对所有紧急医疗服务治疗的心脏骤停和旁观者目击的因假定心脏原因表现为室颤或室性心动过速的患者进行了分析。结果：总体存活率为7.8%(n=833/10,681)，在复苏结果联盟的不同地点，存活率从4.6%到14.7%不等。在旁观者目击的室颤或室性心动过速中，存活率为22.1%(n=323/1459)，不同部位的存活率从12.5%到41.0%不等。Utstein元素共同预测了所有患者中72%的生存变异性和旁观者目击的室颤中40%的生存变异性。Utstein元素解释了所有被捕患者间存活率差异的43.6%，以及旁观者目击的室颤亚组间存活率差异的22.3%。结论：Utstein元素可预测存活率，但仅占总体和复苏结果联盟间结果差异的一小部分。这一结果强调了进行中的研究的必要性，以更好地了解影响心脏骤停存活率的特征。访问数/每百万人：Reach for[Ann Emerg2010；55：249-257。]
Study objective: Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences.Methods: We used an observational, prospective data collection, case-series of adult persons with nontraumatic out-of-hospital cardiac arrest from December 1, 2005, through March 1, 2007, from the multisite, population-based Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. We used logistic regression, receiver operating curves, and measures of variance to estimate the extent to which the Utstein elements predicted survival to hospital discharge and explained outcome variability overall and between 7 Resuscitation Outcomes Consortium sites. Analyses were conducted for all emergency medical services-treated cardiac arrests and for the subset of bystander-witnessed patient arrests because of presumed cardiac cause presenting with ventricular fibrillation or ventricular tachycardia.Results: Survival was 7.8% overall (n=833/10,681) and varied from 4.6% to 14.7% across Resuscitation Outcomes Consortium sites. Among bystander-witnessed ventricular fibrillation or ventricular tachycardia, survival was 22.1% overall (n=323/1459) and varied from 12.5% to 41.0% across sites. The Utstein elements collectively predicted 72% of survival variability among all arrests and 40% of survival variability among bystander-witnessed ventricular fibrillation. The Utstein elements accounted for 43.6% of the between-site survival difference among all arrests and 22.3% of the between-site difference among the bystander-witnessed ventricular fibrillation subset.Conclusion: The Utstein elements predict survival but account for only a modest portion of outcome variability overall and between Resuscitation Outcomes Consortium sites. The results underscore the need for ongoing investigation to better understand characteristics that influence cardiac arrest survival. [Ann Emerg Med. 2010;55:249-257.]