预测院外心脏骤停的生存率。

Lindholm D J, Campbell J P

Emergency Medical Services Section, Department of Health, City of Kansas City, Missouri 64108, USA.

Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):51-4.

OBJECTIVE

To determine the effect of a return of spontaneous circulation (RO SC) on survival to hospital discharge as compared to other established predictors of survival.

METHODS

A retrospective case review of all out-of-hospital primary cardiac arrests from 01 January, 1992 to 31 December 1994 was conducted. The relative values of age, race, gender, presenting cardiac rhythm, witnessed event, initiation of CPR by bystanders, response time intervals, and return of spontaneous circulation (ROSC) in an Utstein-template database were tested as predictors of survival of patients who had suffered a cardiac arrest in the out-of-hospital setting. The ROSC was defined as return of spontaneous circulation prior to and present upon arrival at the emergency department. Predictors were evaluated for statistical significance using a logistic regression analysis (p < 0.05). Odds ratios (OR) and 95% confidence intervals (CI) with positive and negative predictive values (PPV, NPV) were calculated.

RESULTS

Of 832 patients with primary cardiac arrest, 153 (18.4%) had ROSC and 67 (8.1%) survived to hospital discharge. Comparing survivors to nonsurvivors, the mean values for age were 64 to 67 years, with 59.7% to 36.1% being witnessed, 35.8% to 23.9% having bystander CPR initiated, 88.1% to 48.4% having ventricular fibrillation (V-fib) and 82.1% to 64.0% having ROSC. An initial electrocardiographic rhythm of V-fib (p = 0.009; OR = 2.2; CI = 1.2-3.9), and ROSC (p < 0.0001; OR = 5.2; CI = 3.6-7.5) are statistically significant predictors of survival to hospital discharge. The PPV was 13.8% for V-fib and 35.9% for ROSC, and the NPV was 98.0% for V-fib and 98.2% for ROSC.

CONCLUSION

Presenting V-fib and out-of-hospital ROSC are significant predictors of survival from cardiac arrest. Failure to obtain ROSC in the out-of-hospital setting strongly suggests consideration for terminating resuscitation efforts.

目的

与其他已确定的生存预测因素相比，确定自主循环恢复（ROSC）对存活至出院的影响。

方法

对1992年1月1日至1994年12月31日期间所有院外原发性心脏骤停病例进行回顾性研究。在Utstein模板数据库中，对年龄、种族、性别、初始心律、事件是否被目击、旁观者实施心肺复苏（CPR）情况、反应时间间隔以及自主循环恢复（ROSC）等因素的相对价值进行测试，以作为院外心脏骤停患者存活的预测因素。ROSC定义为在到达急诊科之前和到达时出现自主循环恢复。使用逻辑回归分析评估预测因素的统计学意义（p < 0.05）。计算比值比（OR）和95%置信区间（CI）以及阳性和阴性预测值（PPV、NPV）。

结果

在832例原发性心脏骤停患者中，153例（18.4%）出现ROSC，67例（8.1%）存活至出院。将存活者与非存活者进行比较，年龄平均值为64至67岁，事件被目击的比例为59.7%至36.1%，旁观者实施CPR的比例为35.8%至23.9%，出现室颤（V-fib）的比例为88.1%至48.4%，出现ROSC的比例为82.1%至64.0%。初始心电图心律为V-fib（p = 0.009；OR = 2.2；CI = 1.2 - 3.9）和ROSC（p < 0.0001；OR = 5.2；CI = 3.6 - 7.5）是存活至出院的统计学显著预测因素。V-fib的PPV为13.8%，ROSC的PPV为35.9%；V-fib的NPV为98.0%，ROSC的NPV为98.2%。