Cardiac arrest witnessed by emergency medical services personnel: Descriptive epidemiology, prodromal symptoms, and predictors of survival
Cardiac arrest witnessed by emergency medical services personnel: Descriptive epidemiology, prodromal symptoms, and predictors of survival
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DOI：
10.1016/s0196-0644(00)70133-8
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发表时间：
2000-02-01
影响因子：
6.2
通讯作者：
Spaite, DW
中科院分区：
文献类型：
--
作者：
De Maio, VJ;Stiell, IG;Spaite, DW
研究目的：Utstein指南建议，紧急医疗服务(EMS)见证的心脏骤停应与其他院外心脏骤停病例分开考虑。这项研究的目的是评估EMS见证的心脏骤停，并确定这组患者存活的预测因素。方法：这一前瞻性队列包括安大略省医院前高级生命支持(OPALS)研究21个社区中所有EMS见证的心脏骤停的成年人。系统提供基本生命支持和除颤(BLS-D)护理水平。病例和生存的定义遵循Utstein的风格。描述性和单变量方法(X_1(2)和t检验)被用来描述EMS见证的心脏骤停。结果：从1991年1月1日到1996年12月31日，研究社区共有9,072例心脏骤停病例。其中610例(6.7%)为EMS目击病例。大多数患者已有心脏或呼吸系统疾病(81.5%)，并在急救人员到达之前出现前驱症状(91.4%)。50.1%的患者出现无脉性电活动的初始节律，34.2%的患者出现室颤/室性心动过速，15.7%的患者出现停搏。出院存活率为12.6%。多因素分析确定以下因素为生存的独立预测因素(优势比95%可信区间[CI])：到达急救前使用硝酸甘油：2.3(95%可信区间1.2~4.5)，胸痛前驱症状：2.5(95%可信区间1.4~4.5)或呼吸困难：0.5(95%可信区间0.3~1.0)，到达急救时意识障碍：0.5(95%可信区间0.2~0.9)。胸痛患者比呼吸困难患者更容易发生室颤/室性心动过速(62%比17%，P
Study objective: The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group.Methods: This prospective cohort included all adults with an EMS-witnessed cardiac arrest in the 21 communities of the Ontario Prehospital Advanced life Support (OPALS) study. Systems provided a basic life support with defibrillation (BLS-D) level of care. Case and survival definitions followed the Utstein style. Descriptive and univariate methods (chi(2) and t test) were used to characterize EMS-witnessed cardiac arrest. Multivariate logistic regression was undertaken to assess predictors of survival to hospital discharge.Results: From January 1, 1991, to December 31, 1996, there were 9,072 cardiac arrest cases in the study communities. Of these, 610 (6.7%) were EMS-witnessed. The majority had preexisting cardiac or respiratory disease (81.5%) and experienced prodromal symptoms before EMS personnel arrived (91.4%). An initial rhythm of pulseless electrical activity was present in 50.1% of the patients, ventricular fibrillation/ventricular tachycardia in 34.2%, and asystole in 15.7%. Survival to discharge was 12.6%. Multivariate analysis identified the following as independent predictors of survival (odds ratio with 95% confidence intervals [CIs]): nitroglycerin use before EMS arrival: 2.3 (95% CI 1.2 to 4.5), prodromal symptoms of chest pain: 2.5 (95% CI 1.4 to 4.5) or dyspnea: 0.5 (95% CI 0.3 to 1.0), and unconsciousness on EMS arrival: 0.5 (95% CI 0.2 to 0.9). Patients with chest pain were more likely than dyspneic patients to experience ventricular fibrillation/ventricular tachycardia (62% versus 17%, P