Ventricular tachyarrhythmias after cardiac arrest in public versus at home.
Ventricular tachyarrhythmias after cardiac arrest in public versus at home.
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DOI：
10.1056/nejmoa1010663
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发表时间：
2011-01-27
期刊：
影响因子：
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通讯作者：
Resuscitation Outcomes Consortium Investigators
中科院分区：
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作者：
Weisfeldt ML;Everson-Stewart S;Sitlani C;Rea T;Aufderheide TP;Atkins DL;Bigham B;Brooks SC;Foerster C;Gray R;Ornato JP;Powell J;Kudenchuk PJ;Morrison LJ;Resuscitation Outcomes Consortium Investigators
出院心脏骤停后，作为第一个记录节律的室颤或无脉性室性心动过速的发生率出人意料地下降。旁观者部署的自动体外除颤器(AED)在公共场合的成功表明，这可能是医院外心脏骤停在公共场合发生时更常见的初始节律。我们进行了一项研究，以确定心搏骤停的位置、心律失常的类型和存活的可能性是否相关。在2005至2007年间，我们在北美10个社区进行了一项关于成人院外心脏骤停的前瞻性队列研究。我们评估了室颤或无脉性室性心动过速的发生率，以及因在家中被捕而出院的存活率，并与在公共场所的被捕进行了比较。在评估的12,930例院外心脏骤停中，2042例发生在公共场合，9564例发生在家里。在家中心脏骤停时，当紧急医疗服务(EMS)人员目睹心脏骤停时，室颤或无脉性室性心动过速的发生率为25%，当旁观者目睹时，室颤或无脉室性心动过速的发生率为35%，当旁观者应用AED时，室颤或无脉室性心动过速的发生率为36%。在公共场合心脏骤停，相应的发生率分别为38%、60%和79%。旁观者目击的逮捕与旁观者使用AEDs的逮捕相比，公共场所初发室颤或无脉室性心动过速的调整后优势比为2.28(95%可信区间，1.96至2.66；P<；0.001)和4.48(95%CI，2.23至8.97；P<；0.001)。在公共场所使用AEDs的患者存活至出院的比率为34%，而在家中使用AEDs的患者为12%(调整后的优势比为2.49；95%可信区间为1.03至5.99；P=0.04)。无论是EMS人员还是旁观者目睹了医院外的心脏骤停，无论AEDs是由旁观者使用的，在公共场所出现初发室颤或无脉性室性心动过速的心脏骤停的比例都比在家里大得多。复苏策略的增量价值，如AED的现成供应，可能与逮捕发生的地点有关。(由国家心肺血液研究所等资助。)
The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when out-of-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated. Between 2005 and 2007, we conducted a prospective cohort study of out-of-hospital cardiac arrest in adults in 10 North American communities. We assessed the frequencies of ventricular fibrillation or pulseless ventricular tachycardia and of survival to hospital discharge for arrests at home as compared with arrests in public. Of 12,930 evaluated out-of-hospital cardiac arrests, 2042 occurred in public and 9564 at home. For cardiac arrests at home, the incidence of ventricular fibrillation or pulseless ventricular tachycardia was 25% when the arrest was witnessed by emergency-medical-services (EMS) personnel, 35% when it was witnessed by a by-stander, and 36% when a bystander applied an AED. For cardiac arrests in public, the corresponding rates were 38%, 60%, and 79%. The adjusted odds ratio for initial ventricular fibrillation or pulseless ventricular tachycardia in public versus at home was 2.28 (95% confidence interval [CI], 1.96 to 2.66; P<0.001) for bystander-witnessed arrests and 4.48 (95% CI, 2.23 to 8.97; P<0.001) for arrests in which bystanders applied AEDs. The rate of survival to hospital discharge was 34% for arrests in public settings with AEDs applied by bystanders versus 12% for arrests at home (adjusted odds ratio, 2.49; 95% CI, 1.03 to 5.99; P = 0.04). Regardless of whether out-of-hospital cardiac arrests are witnessed by EMS personnel or bystanders and whether AEDs are applied by bystanders, the proportion of arrests with initial ventricular fibrillation or pulseless ventricular tachycardia is much greater in public settings than at home. The incremental value of resuscitation strategies, such as the ready availability of an AED, may be related to the place where the arrest occurs. (Funded by the National Heart, Lung, and Blood Institute and others.)