Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest.
Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest.
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DOI：
10.1007/s12245-009-0084-0
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发表时间：
2009-04
影响因子：
3.2
通讯作者：
Podgorsek, Dejan
中科院分区：
文献类型：
--
作者：
Grmec, Stefek;Strnad, Matej;Podgorsek, Dejan
2003年，国际复苏联络委员会（ILCOR）发布了《溺水数据统一报告建议指南：“Utstein风格”（“Utstein Style for Drowning”，USFD）》，以提高对溺水后流行病学、治疗和结局预测的理解。本研究的目的是通过基于USFD的变量分析，比较院外原发性心脏骤停（OHPCA）和溺水心脏骤停（DCA）患者的特征和结局。所有病例均纳入1998年2月至2007年2月的OHPCA和DCA病例。使用Utstein方法收集OHPCA和DCA患者的数据。然后将DCA患者的数据与OHPCA患者的数据进行比较。在研究期间，确定了788例尝试复苏的心脏骤停：其中528例为OHPCA（67%），32例为DCA（4%）。DCA与OHPCA患者的差异为：DCA患者年龄较小（46.5 ± 21.4 vs 62.5 ± 15.8; p = 0.01），发生目击心脏骤停的频率较低（9/32 vs 343/528; p = 0.03），更常见于不可电击心律（29/32 vs 297/528; p < 0.0001），救护车响应时间延长（11对6 min; p = 0.001），有一个相对更好的（但无统计学显著性）现场自主循环（ROSC）恢复[22/32（65%）vs 301/528（57%）; P = 0.33]，更多的患者入院[19/32（60%）vs 253/528（48%; P = 0.27）]，并且生存率也显著更高（出院）[14/32（44%）vs 116/528（22%）; p = 0.01]。DCA患者的初始PETCO 2值（53.2 ± 16.8 vs 15.8 ± 8.3 mmHg; p < 0.0001）和平均PETCO 2值（43.5 ± 13.8 vs 23.5 ± 8.2; p = 0.002）较高。PETCO 2的这些值表明心脏骤停的窒息机制。结果显示，存活的DCA患者与死亡的DCA患者相比，年龄更小，有更多的旁观者进行心肺复苏（CPR），呼叫到达时间更短，CPR后1 min PETCO 2值更高，PETCO 2的平均值和最终值更高，初始血清K+值更低，并且更多的人接受了加压素治疗（p < 0.05）。DCA患者有更好的存活率（出院），更高的初始和平均PETCO 2值，更多的患者具有不可电击的初始心律。DCA患者的生存率（出院）与PETCO 2值、初始血清K+值、加压素给药和救护车响应时间相关。
In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the Recommended Guidelines for Uniform Reporting of Data from Drowning: the “Utstein style” (“Utstein Style for Drowning,” USFD) to improve the understanding of epidemiology, treatment, and outcome prediction after drowning. The aim of this study was to compare the characteristics and outcome between patients suffering from out-of-hospital primary cardiac arrest (OHPCA) and drowning victims in cardiac arrest (DCA) by analysis of variables based on the USFD. All cases of OHPCA and DCA from February 1998 to February 2007 were included in the research and analysis. Data on OHPCA and DCA patients were collected using the Utstein method. Data on DCA patients were then compared with data of OHPCA patients. During the study period 788 cardiac arrests with resuscitation attempts were identified: 528 of them were OHPCA (67%) and 32 (4%) were DCA. The differences between DCA and OHPCA patients were: the DCA patients were younger (46.5 ± 21.4 vs 62.5 ± 15.8; p = 0.01), suffered a witnessed cardiac arrest less frequently (9/32 vs 343/528; p = 0.03), were more often found in a nonshockable rhythm (29/32 vs 297/528; p < 0.0001), had a prolonged ambulance response time (11 vs 6 min; p = 0.001), had a relatively better (but not statistically significant) return of spontaneous circulation (ROSC) in the field [22/32 (65%) vs 301/528 (57%); p = 0.33], more of them were admitted to hospital [19/32 (60%) vs 253/528 (48%); p = 0.27], and also had a significantly higher survival rate (discharge from hospital) [14/32 (44%) vs 116/528 (22%); p = 0.01]. DCA patients had higher values of initial PETCO2 (53.2 ± 16.8 vs 15.8 ± 8.3 mmHg; p < 0.0001) and average PETCO2 (43.5 ± 13.8 vs 23.5 ± 8.2; p = 0.002). These values of PETCO2 suggest an asphyxial mechanism of cardiac arrest. The analysis showed that DCA patients who survived were younger, had more bystander cardiopulmonary resuscitation (CPR), shorter call-arrival interval, higher values of PETCO2 after 1 min of CPR, higher average and final values of PETCO2, lower value of initial serum K+, and more of them received vasopressin (p < 0.05) in comparison with DCA patients who did not survive. DCA patients had a better survival rate (discharge from hospital), higher initial and average PETCO2 values, and more of them had nonshockable initial rhythm. Survival (discharge from hospital) in DCA patients is associated with the PETCO2 values, initial serum K+ values, administration of vasopressin, and ambulance response time.