Layon A Joseph, Gabrielli Andrea, Goldfeder Bruce W, Hevia Armando, Idris Ahamed H
Department of Anesthesiology, College of Medicine, University of Florida, PO Box 100254, Gainesville, FL 32610-0254, USA.
Resuscitation. 2003 Jan;56(1):59-66. doi: 10.1016/s0300-9572(02)00273-3.
Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors.
We studied all OOHCAs in 1998 for rural Alachua County, Florida, with one emergency medical system (EMS) transport provider and three hospitals. All EMS identified OOHCA were reviewed retrospectively, as were EMS and hospital records. The 1998 County population was 211403; 1495 deaths from all causes occurred (70.7/10(4) pop). Of 167 OOHCAs (7.9/10(4) pop), 145 were of cardiac etiology; 22 were excluded (13 scene deaths, four traumatic, one intraoperative and three respiratory arrests, one arrest during a hospital-to-hospital transfer) and in eight outcome data were not available in any form. A total of 137/145 (94.5%) OOHCA patients had analyzable data. Data were analyzed using Student's t-test and ANOVA. Alpha was set at 0.05.
Of 25 patients (18.2% of OOHCA) with restoration of spontaneous circulation (ROSC), six survived (4.4% of total, 24% of those with ROSC) to discharge from hospital (four to a skilled nursing facility, one each home with and without assistance). Four patients were still alive at >or=1 year post arrest. Asystole as the initial rhythm (P=0.014), and emergency department (ED) CPR time (8 vs. 15.5 min, P=0.042 for survivors vs. non-survivors) were the only factors statistically affecting survival. While bystander CPR was not significantly different between groups, there was a significantly higher proportion of patients surviving in the ED who had ROSC, and a higher proportion who had ROSC after bystander CPR. Time to defibrillation in nonsurvivors, while not statistically different between city and county patient groups, was clinically different. Statistical significance would likely have been achieved with a larger study population.
Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.
在城市环境中，院外心脏骤停（OOHCA）后的生存率与除颤速度及有效的旁观者心肺复苏（CPR）直接相关。我们推测农村地区院外心脏骤停的出院率也受相同因素影响。
我们研究了佛罗里达州阿拉楚阿县农村地区1998年所有院外心脏骤停病例，该县有一个紧急医疗服务（EMS）转运机构和三家医院。对所有EMS确认的院外心脏骤停病例进行回顾性分析，同时分析EMS和医院记录。1998年该县人口为211403；全因死亡1495例（70.7/10⁴人口）。在167例院外心脏骤停病例（7.9/10⁴人口）中，145例为心脏病因；22例被排除（13例现场死亡、4例创伤性、1例术中及3例呼吸骤停、1例在医院间转运时骤停），8例无法获取任何形式的结局数据。共有137/145例（94.5%）院外心脏骤停患者有可分析数据。数据采用学生t检验和方差分析进行分析。α设定为0.05。
在25例恢复自主循环（ROSC）的患者（占院外心脏骤停患者的18.2%）中，6例存活（占总数的4.4%，占恢复自主循环患者的24%）至出院（4例入住专业护理机构，1例在家中，1例在家中但需协助）。4例患者在心脏骤停后≥1年仍存活。初始心律为心搏停止（P = 0.014）以及急诊科（ED）心肺复苏时间（存活者与非存活者分别为8分钟和15.5分钟，P = 0.042）是仅有的对生存有统计学影响的因素。虽然两组间旁观者心肺复苏无显著差异，但在急诊科恢复自主循环的患者中存活比例显著更高，且在旁观者心肺复苏后恢复自主循环的比例也更高。非存活者的除颤时间，虽然城市和农村患者组间无统计学差异，但在临床上有所不同。样本量更大的研究可能会得出统计学显著性结果。
我们的数据表明，缩短反应时间和改善旁观者心肺复苏可能会进一步提高农村地区的生存率。
