Recent trends in survival from out-of-hospital cardiac arrest in the United States.
Recent trends in survival from out-of-hospital cardiac arrest in the United States.
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DOI：
10.1161/circulationaha.114.009711
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发表时间：
2014-11-18
期刊：
影响因子：
37.8
通讯作者：
CARES Surveillance Group
中科院分区：
文献类型：
--
作者：
Chan PS;McNally B;Tang F;Kellermann A;CARES Surveillance Group
尽管多年来付出了巨大努力，但美国在提高院外心脏骤停（OHCA）生存率方面取得的进展有限。最近，国家组织，如美国心脏协会，已专注于促进旁观者心肺复苏术（CPR），使用自动体外除颤器（AED），和其他性能改进的努力。使用心脏骤停登记以提高生存率（CARES），一项前瞻性临床登记研究，我们确定了2005年10月至2012年12月期间经历OHCA的70，027名美国患者。使用多水平泊松回归，我们研究了风险调整生存率的时间趋势。调整患者和心脏骤停特征后，OHCA生存率的风险调整率从2005-2006年参考期的5.7%增加到2008年的7.2%（调整后风险比，1.27; 95%CI，1.12-1.43; P<0.001）。2012年生存率略有改善，为8.3%（调整后的风险比，1.47; 95%CI，1.26-1.70; P<0.001）。这种生存率的改善发生在可电击和不可电击的停搏节律中（相互作用P =0.22），并且还伴随着幸存者中更好的神经学结局（趋势P =0.01）。生存率的提高是由于院前生存率的提高，其中风险调整率从2005-2006年的14.3%增加到2012年的20.8%（趋势P <0.001）和住院生存率（趋势P =0.015）。旁观者CPR和AED使用率在研究期间适度增加，部分解释了院前生存趋势。从美国社区的一个大的子集得出的数据表明，从OHCA的生存率提高了参与性能改进注册表的网站。
Despite intensive efforts over many years, the U.S. has made limited progress in improving rates of survival from out-of-hospital cardiac arrest (OHCA). Recently, national organizations, such as the American Heart Association, have focused on promoting bystander cardiopulmonary resuscitation (CPR), use of automated external defibrillators (AEDs), and other performance improvement efforts. Using the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective clinical registry, we identified 70,027 U.S. patients who experienced an OHCA between October 2005 and December 2012. Using multilevel Poisson regression, we examined temporal trends in risk-adjusted survival. After adjusting for patient and cardiac arrest characteristics, risk-adjusted rates of OHCA survival increased from 5.7% in the reference period of 2005-2006 to 7.2% in 2008 (adjusted risk ratio, 1.27; 95% CI, 1.12-1.43; P<0.001). Survival improved more modestly to 8.3% in 2012 (adjusted risk ratio, 1.47; 95% CI, 1.26-1.70; P<0.001). This improvement in survival occurred in both shockable and non-shockable arrest rhythms (P for interaction=0.22) and was also accompanied by better neurological outcomes among survivors (P for trend=0.01). Improved survival was due to both higher rates of pre-hospital survival, where risk-adjusted rates increased from 14.3% in 2005-2006 to 20.8% in 2012 (P for trend<0.001), and in-hospital survival (P for trend=0.015). Rates of bystander CPR and AED use modestly increased during the study period and partly accounted for pre-hospital survival trends. Data drawn from a large subset of U.S communities suggest that rates of survival from OHCA have improved among sites participating in a performance improvement registry.