Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation
Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation
复制标题
DOI：
10.1056/nejmoa023053
复制
发表时间：
2003-06-26
影响因子：
158.5
通讯作者：
Packer, DL
中科院分区：
文献类型：
--
作者：
Bunch, TJ;White, RD;Packer, DL
背景：院外心室颤动引起的心脏骤停的死亡率很高。注重早期除颤的项目提高了患者的存活率。我们对幸存者的长期预后和生活质量进行了基于人群的分析。方法：纳入1990年11月至2001年1月期间在明尼苏达州奥姆斯特德县因心室颤动而接受早期除颤治疗的所有院外心脏骤停患者。将生存率与年龄、性别和疾病匹配（2:1）的未发生院外心脏骤停的居民对照人群和年龄和性别匹配的美国普通人群的对照人群进行比较。使用医疗结果研究36项简短一般健康调查（SF-36）评估生活质量，并与美国人口标准进行比较。结果：在200例院外心脏骤停合并心室颤动的患者中，145例（72%）存活至住院（7例死于急诊科），79例（40%）出院时神经功能完好（整体功能良好或中度整体残疾）。平均（+/-SD）随访时间为4.8+/-3.0年。19名患者出院后死亡。预期的五年生存率（79%）与年龄、性别和疾病匹配的对照组相同（P=0.68），但低于年龄和性别匹配的美国人群（86%，P=0.02）。50名患者在随访结束时完成了SF-36调查，除了活力下降外，大多数患者的生活质量几乎正常。结论：院外心脏骤停后接受快速除颤的患者的长期生存率与年龄、性别和疾病匹配的未发生院外心脏骤停的患者相似。大多数幸存者的生活质量与一般人口的生活质量相似。
BACKGROUND: Mortality after out-of-hospital cardiac arrest from ventricular fibrillation is high. Programs focusing on early defibrillation have improved the rate of survival to hospital discharge. We conducted a population-based analysis of the long-term outcome and quality of life of survivors.METHODS: All patients who had an out-of-hospital cardiac arrest between November 1990 and January 2001 who received early defibrillation for ventricular fibrillation in Olmsted County, Minnesota, were included. The survival rate was compared with that of an age-, sex-, and disease-matched (2:1) control population of residents who had not had an out-of-hospital cardiac arrest and with that of age- and sex-matched controls from the general U.S. population. The quality of life was assessed with use of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and compared with U.S. population norms.RESULTS: Of 200 patients who presented with an out-of-hospital cardiac arrest with ventricular fibrillation, 145 (72 percent) survived to hospital admission (7 died in the emergency department) and 79 (40 percent) were neurologically intact (good overall capability or moderate overall disability) at discharge. The mean (+/-SD) length of follow-up was 4.8+/-3.0 years. Nineteen patients died after discharge from the hospital. The expected five-year survival rate (79 percent) was identical to that among age-, sex-, and disease-matched controls (P=0.68) but lower than that among the age- and sex-matched U.S. population (86 percent, P=0.02). Fifty patients completed SF-36 surveys at the end of follow-up, and the majority had a nearly normal quality of life, with the exception of reduced vitality.CONCLUSIONS: Long-term survival among patients who have undergone rapid defibrillation after out-of-hospital cardiac arrest is similar to that among age-, sex-, and disease-matched patients who did not have out-of-hospital cardiac arrest. The quality of life among the majority of survivors is similar to that of the general population.