Regional variation in out-of-hospital cardiac arrest incidence and outcome.
Regional variation in out-of-hospital cardiac arrest incidence and outcome.
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DOI：
10.1001/jama.300.12.1423
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发表时间：
2008-09-24
影响因子：
120.7
通讯作者：
Stiell, Ian
中科院分区：
文献类型：
--
作者：
Nichol, Graham;Thomas, Elizabeth;Callaway, Clifton W.;Hedges, Jerris;Powell, Judy L.;Aufderheide, Tom P.;Rea, Tom;Lowe, Robert;Brown, Todd;Dreyer, John;Davis, Dan;Idris, Ahamed;Stiell, Ian
院外心脏骤停发生率和结局的区域差异对健康和政策的影响仍有待确定。复苏结果联盟进行临床研究，以改善北美11个地点院外心脏骤停后的预后。评估不同地理区域的心脏骤停发生率和预后是否存在差异。2006年5月1日至2007年4月30日出院后所有院外心脏骤停患者的前瞻性多中心观察研究。这些病例由有组织的紧急医疗服务(EMS)人员进行评估，没有创伤性损伤，并接受了体外除颤或胸部按压的尝试；或者没有尝试复苏。所包括的数据截至2008年6月28日可用。排除的是一个病例捕获不完整的站点。人口普查数据被用来确定根据年龄和性别调整的比率。EMS评估患者的发病率、死亡率、病死率和出院存活率，接受EMS治疗或有初始室颤节律的患者。流域总人口为2140万人。在10个地点有20520人被捕。患者年龄0~108岁。61%是男性。有11898人(占总数的58.0%)尝试过复苏。2729例(22.9%)有室颤、室性心动过速或可被自动体外除颤器电击的起始性心律失常。954人(4.6%)活着出院。跨地点每10万人接受EMS治疗的心脏骤停的中位数为52.1(四分位数范围(IQR)48.0，70.1)；存活率从3.0%到16.2%，中位数8.5%(IQR5.2%，10.2%)。室颤发生率中位数12.6(IQR10.6，15.2)，生存率7.7%~39.4%，中位数21.8%(IQR14.8%，25.1%)。不同地点差异的所有p值均为0.001。我们观察到院外心脏骤停发生率和结局的显著和重要的地区差异，这需要更多的调查来改善公共健康。
The health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined. The Resuscitation Outcomes Consortium conducts clinical research to improve outcomes after out-of-hospital cardiac arrest in 11 North American sites. To evaluate whether cardiac arrest incidence and outcome differ across geographic regions. Prospective multi-center observational study of all out-of-hospital cardiac arrests from May 1, 2006 to April 30, 2007 followed to hospital discharge. Cases were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation, or chest compressions; or resuscitation was not attempted. Included data were available as of June 28, 2008. Excluded was one site with incomplete case capture. Census data were used to determine rates adjusted for age and gender. Incidence rate, mortality rate, case fatality rate and survival to discharge for patients assessed by EMS, treated by EMS or with an initial rhythm of ventricular fibrillation. The total catchment population was 21.4 million. There were 20,520 arrests in 10 sites. Patients were aged 0-108 years. 61% were men. 11,898 (58.0% of total) had resuscitation attempted. 2,729 (22.9% of treated) had initial rhythm of ventricular fibrillation, ventricular tachycardia or were shockable by an automated external defibrillator. 954 (4.6%) were discharged alive. EMS-treated cardiac arrest per 100,000 population across sites was median 52.1 (interquartile range (IQR) 48.0, 70.1); survival ranged from 3.0% to 16.2%, median 8.5% (IQR 5.2%, 10.2%). Ventricular fibrillation incidence was median 12.6 (IQR 10.6, 15.2); survival ranged from 7.7% to 39.4%, median 21.8% (IQR 14.8%, 25.1%). All p-values for differences across sites were < 0.001. We observed significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome, which require additional investigation to improve public health.
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影响因子：
120.7
作者：
Luepker, RV;Raczynski, JM;Simons-Morton, DG
通讯作者：
Simons-Morton, DG
影响因子：
6
作者：
Domanski, MJ;Krause-Steinrauf, H;Eichhorn, E
通讯作者：
Eichhorn, E
影响因子：
5.7
作者：
Herlitz, J;Bång, A;Waagstein, L
通讯作者：
Waagstein, L
影响因子：
5.9
作者：
Menon, Venu;Rumsfeld, John S.;Ohman, E. Magnus
通讯作者：
Ohman, E. Magnus
影响因子：
158.5
作者：
Bernard, SA;Gray, TW;Smith, K
通讯作者：
Smith, K