Herlitz J, Eek M, Holmberg M, Engdahl J, Holmberg S
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Heart. 2002 Dec;88(6):579-82. doi: 10.1136/heart.88.6.579.
To describe the characteristics and outcome of patients who have a cardiac arrest at home compared with elsewhere out of hospital.
Subjects were patients included in the Swedish cardiac arrest registry between 1990 and 1999. The registry covers about 60% of all ambulance organisations in Sweden.
The study sample comprised patients reached by the ambulance crew and in whom resuscitation was attempted out of hospital. There was no age limit. Crew witnessed cases were excluded. The patients were divided into two groups: cardiac arrest at home and cardiac arrest elsewhere.
Among a study population of 24 630 patients the event took place at home in 16 150 (65.5%). Those in whom the arrest took place at home differed from the remainder in that they were older, were more often women, less often had a witnessed cardiac arrest, were less often exposed to bystander cardiopulmonary resuscitation (CPR), were less often found in ventricular fibrillation, and had a longer interval between collapse and call for ambulance, arrival of ambulance, start of CPR, and first defibrillation. Of patients in whom the arrest took place at home, 11.3% were admitted to hospital alive, v 19.4% in the elsewhere group (p < 0.0001); corresponding figures for survival after one month were 1.7% v 6.2% (p < 0.0001). The adjusted odds ratio for survival after one month (at home v not at home; considering age, sex, initial arrhythmia, bystander CPR, aetiology, and whether the arrest was witnessed) was 0.40 (95% confidence interval 0.33 to 0.49; p < 0.0001).
Sixty five per cent of out of hospital cardiac arrests in Sweden occur at home. The patients differed greatly from those with out of hospital cardiac arrests elsewhere, and fewer than 2% were alive after one month. Having an arrest at home was a strong independent predictor of adverse outcome. Further research is needed to identify the reasons for this.
描述在家中发生心脏骤停的患者与在医院外其他地方发生心脏骤停的患者的特征及预后。
研究对象为1990年至1999年纳入瑞典心脏骤停登记处的患者。该登记处涵盖了瑞典约60%的所有救护机构。
研究样本包括救护人员到达现场且在医院外尝试进行复苏的患者。无年龄限制。排除救护人员目击的病例。患者被分为两组：在家中发生心脏骤停和在其他地方发生心脏骤停。
在24630例研究人群中，16150例（65.5%）在家中发生该事件。在家中发生心脏骤停的患者与其余患者的不同之处在于，他们年龄更大，女性更多，目击心脏骤停的情况更少，接受旁观者心肺复苏（CPR）的情况更少，发生心室颤动的情况更少，并且从晕倒到呼叫救护车、救护车到达、开始CPR以及首次除颤之间的间隔时间更长。在家中发生心脏骤停的患者中，11.3%存活入院，而在其他地方发生心脏骤停的患者组中这一比例为19.4%（p<0.0001）；1个月后存活的相应比例分别为1.7%和6.2%（p<0.0001）。1个月后存活的校正比值比（在家中与不在家中；考虑年龄、性别、初始心律失常、旁观者CPR、病因以及心脏骤停是否被目击）为0.40（95%置信区间0.33至0.49；p<0.0001）。
瑞典65%的院外心脏骤停发生在家中。这些患者与在医院外其他地方发生心脏骤停的患者有很大差异，1个月后存活者不到2%。在家中发生心脏骤停是不良预后的有力独立预测因素。需要进一步研究以确定其原因。
