Paramedic Out-of-hospital Cardiac Arrest Case Volume Is a Predictor of Return of Spontaneous Circulation
Paramedic Out-of-hospital Cardiac Arrest Case Volume Is a Predictor of Return of Spontaneous Circulation
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护理人员院外心脏骤停病例量是自主循环恢复的预测因素
DOI：
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发表时间：
2018
影响因子：
3.1
通讯作者：
M. Hubble
中科院分区：
文献类型：
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作者：
J. Tuttle;M. Hubble
引言许多因素有助于院外心脏骤停（OHCA）的生存。其中一个因素是复苏努力的质量，这反过来又可能是OHCA病例数量的函数。然而，很少有研究调查OHCA的病例数量与生存率的关系。因此，我们试图建立一个模型，描述恢复自主循环（ROSC）的可能性作为护理人员累积OHCA经验的函数。方法我们使用北卡罗来纳州院前护理报告系统对心脏骤停进行了全州范围的回顾性研究。纳入了2012年1月至2014年6月期间发生目击的非创伤性心脏骤停的成年患者。使用逻辑回归，我们计算了前五年辅助OHCA病例量对ROSC影响的调整比值比（OR），同时控制了先验确定的潜在混杂变量，如患者年龄，性别和非高加索人种;电击呈现节律;外行/第一反应者心肺复苏（CPR）;和紧急医疗服务（EMS）响应时间。结果在符合纳入标准的6,405例患者中，3,155例（49.3%）发生了ROSC。在过去5年中，接受护理人员治疗且有≥ 15次OHCA经历的患者更可能发生ROSC（OR [1.21]，p<0.01）。在具有可电击初始心律（OR [2.35]，p<0.01）和接受外行/第一反应者CPR（OR [1.77]，p<0.01）的患者中，ROSC也更可能发生。增加患者年龄（OR [0.996]，p=0.02）、男性（OR [0.742]，p<0.01）和增加EMS响应时间（OR [0.954]，p<0.01）与ROSC可能性降低相关。非高加索人种不是ROSC的独立预测因子。结论我们发现，护理人员5年OHCA病例数≥ 15例与ROSC显著相关。需要进一步的研究来确定这些更有经验的护理人员的具体行动，他们负责增加ROSC的可能性，以及病例数量对出院和神经功能的长期结局指标的影响。
Introduction Many factors contribute to the survival of out-of-hospital cardiac arrest (OHCA). One such factor is the quality of resuscitation efforts, which in turn may be a function of OHCA case volume. However, few studies have investigated the OHCA case volume-survival relationship. Consequently, we sought to develop a model describing the likelihood of return of spontaneous circulation (ROSC) as a function of paramedic cumulative OHCA experience. Methods We conducted a statewide retrospective study of cardiac arrest using the North Carolina Prehospital Care Reporting System. Adult patients suffering a witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Using logistic regression, we calculated an adjusted odds ratio (OR) for the influence of the preceding five-year paramedic OHCA case volume on ROSC while controlling for the potentially confounding variables identified a priori as patient age, gender, and non-Caucasian race; shockable presenting rhythm; layperson/first responder cardiopulmonary resuscitation (CPR); and emergency medical services (EMS) response time. Results Of the 6,405 patients meeting inclusion criteria, 3,155 (49.3%) experienced ROSC. ROSC was more likely among patients treated by paramedics with ≥ 15 OHCA experiences during the preceding five years (OR [1.21], p<0.01). ROSC was also more likely among patients with shockable initial rhythms (OR [2.35], p<0.01) and who received layperson/first responder CPR (OR [1.77], p<0.01). Increasing patient age (OR [0.996], p=0.02), male gender (OR [0.742], p<0.01), and increasing EMS response time (OR [0.954], p<0.01) were associated with a decreased likelihood of ROSC. Non-Caucasian race was not an independent predictor of ROSC. Conclusion We found that a paramedic five-year OHCA case volume of ≥ 15 is significantly associated with ROSC. Further study is needed to determine the specific actions of these more experienced paramedics who are responsible for the increased likelihood of ROSC, as well as the influence of case volume on the longer-term outcome measures of hospital discharge and neurological function.