Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest
Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest
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DOI：
10.1136/bmj.312.7047.1633
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发表时间：
1996-06-29
影响因子：
--
通讯作者：
Marsden, AK
中科院分区：
文献类型：
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作者：
Cobbe, SM;Dalziel, K;Marsden, AK
目的：确定在院外心脏骤停复苏成功后入院的患者的短期和长期预后。设计：回顾救护车和医院记录。通过与总登记员“标记”来跟踪死亡率。考克斯比例风险分析的预测死亡率的患者出院活着从医院。设置-苏格兰救护车服务和急性医院在整个苏格兰。受试者-1476名患者入院病房，其中680（46%）出院活着。主要结果测量-生存出院，出院时的神经系统状态，死亡时间，结果：存活出院的患者中位住院时间为10天（四分位数间距8-15），在医院死亡的患者中位住院时间为1（1-4）天。605例（89%）幸存者出院时神经系统状态正常或轻度受损，58例（8.5%）中度受损，13例（2%）重度受损; 1例患者昏迷。622例（91%）病例直接出院回家。对680名出院的幸存者进行了中位25个月（范围0-68）的随访。死亡176例，其中81例为心源性猝死，55例为非心源性猝死，40例为其他原因。出院后4年生存率的产品极限估计值为68%。随访死亡率的独立预测因素是年龄的增加，心力衰竭的治疗，心脏骤停，而不是由于明确的myocardialinfarction. Conclusion-约40%的最初的幸存者复苏出院回家没有重大的神经功能障碍。可以识别出随后心源性死亡风险较高的患者，并可能从进一步的心脏病学评估中获益。
Objectives-To determine the short and long term outcome of patients admitted to hospital after initially successful resuscitation from cardiac arrest out of hospital.Design-Review of ambulance and hospital records. Follow up of mortality by ''flagging'' with the registrar general. Cox proportional hazards analysis of predictors of mortality in patients discharged alive fi om hospital.Setting-Scottish Ambulance Service and acute hospitals throughout Scotland.Subjects-1476 patients admitted to a hospital ward, of whom 680 (46%) were discharged alive.Main outcome measures-Survival to hospital discharge, neurological status at discharge, time to death, and cause of death after discharge.Results-The median duration of hospital stay was 10 days (interquartile range 8-15) in patients discharged alive and 1 (1-4) day in those dying in hospital. Neurological status at discharge in survivors was normal or mildly impaired in 605 (89%), moderately impaired in 58 (8.5%), and severely impaired in 13 (2%); one patient was comatose. Direct discharge to home occurred in 622 (91%) cases. The 680 discharged survivors were followed up for a median of 25 (range 0-68) months. There were 176 deaths, of which 81 were sudden cardiac deaths, 55 were non-sudden cardiac deaths, and 40 were due to other causes. The product limit estimate of 4 year survival after discharge was 68%. The independent predictors of mortality on follow up were increased age, treatment for heart failure, and cardiac arrest not due to definite myocardial infarction.Conclusion-About 40% of initial survivors of resuscitation out of hospital are discharged home without major neurological disability. Patients at high risk of subsequent cardiac death can be identified and may benefit from further cardiological evaluation.