Polentini Mark S, Pirrallo Ronald G, McGill William
Emergency Physicians of West Allis Memorial Hospital, West Allis, WI, USA.
Prehosp Emerg Care. 2006 Jan-Mar;10(1):52-60. doi: 10.1080/10903120500366961.
To investigate the changes in annual incidence and survival of out-of-hospital cardiac-etiology arrests of different initial rhythms, particularly ventricular fibrillation (VF) and ventricular tachycardia (VT), among adults (> 21 years old) in Milwaukee County between 1992 and 2002 and establish correlations with patient and emergency medical services (EMS) system-dependent factors.
The study was a retrospective, observational study of all adult (> 21-year-old) patients with out-of-hospital cardiac-etiology arrests with identifiable rhythm and resuscitation attempted by the Milwaukee County EMS system from 1992 to 2002. Nine thousand one hundred seventy cases were enrolled. Primary outcome measures were changes in annual incidence of initial cardiac arrest rhythm, with a focus on VF/VT. Secondary outcome measures were changes in survival to hospital admission and hospital discharge for VF and VT. Patient and EMS system factors potentially affecting the outcome measures were identified and modeled using multivariate logistic regression.
The incidence of out-of-hospital VF/VT arrests decreased steadily from 37.1 per 100,000 in 1992 to 19.4 per 100,000 in 2002. While the incidences of pulseless electrical activity and overall cardiac arrest remained unchanged, the incidence of asystole during the study period increased from 27.3/100,000 to 44.9/100,000. Multivariate regression analyses revealed that age < 80 years, male gender, white race, previous cardiac surgery, and cardiac history were patient-dependent factors predictive of VF/VT. Witnessed arrest, public location, and shorter response time were EMS system-dependent factors predictive of VF/VT. Based on observed trends, none of these correlated factors could explain the decrease in the incidence of VF/VT arrests. Rates of patient survival to hospital admission and discharge were not significantly changed over time. EMS system factors predictive of survival to admission and discharge were witnessed arrest, public location, and decreased number of defibrillations. Prior cardiac surgery and absence of chronic problems were the only patient factors predictive of survival to hospital admission but were not significantly related to survival to hospital discharge.
The incidence of out-of-hospital cardiac arrests in adult patients with presenting rhythm of VF/VT declined, while an increase in asystole occurred. This was not explained by any patient or EMS system-dependent factor. Rate of survival for VF/VT arrest did not significantly change over time. Survival was primarily influenced by EMS system factors and unrelated to patient-dependent factors.
调查1992年至2002年间密尔沃基县21岁以上成年人院外心脏病因性心脏骤停（尤其是室颤和室速）的年发病率和生存率变化，并确定与患者及依赖急诊医疗服务（EMS）系统的因素之间的相关性。
本研究是一项回顾性观察研究，对象为1992年至2002年间所有院外心脏病因性心脏骤停、心律可识别且由密尔沃基县EMS系统尝试进行复苏的21岁以上成年患者。共纳入9170例病例。主要结局指标是初始心脏骤停心律的年发病率变化，重点是室颤/室速。次要结局指标是室颤和室速患者入院及出院时的生存率变化。使用多因素逻辑回归确定并建立可能影响结局指标的患者和EMS系统因素模型。
院外室颤/室速性心脏骤停的发病率从1992年的每10万人37.1例稳步下降至2002年的每10万人19.4例。虽然无脉电活动和总体心脏骤停的发病率保持不变，但研究期间心脏停搏的发病率从每10万人27.3例增至每10万人44.9例。多因素回归分析显示，年龄<80岁、男性、白人、既往心脏手术史和心脏病史是预测室颤/室速的患者相关因素。目睹心脏骤停、公共场所发病和较短的响应时间是预测室颤/室速的EMS系统相关因素。基于观察到的趋势，这些相关因素均无法解释室颤/室速性心脏骤停发病率的下降。患者入院和出院时的生存率随时间未发生显著变化。预测入院和出院生存率的EMS系统因素为目睹心脏骤停、公共场所发病和除颤次数减少。既往心脏手术和无慢性疾病是仅有的预测入院生存率的患者因素，但与出院生存率无显著相关性。
以室颤/室速为初始心律的成年患者院外心脏骤停发病率下降，而心脏停搏发病率上升。这无法用任何患者或EMS系统相关因素来解释。室颤/室速性心脏骤停的生存率随时间未发生显著变化。生存率主要受EMS系统因素影响，与患者相关因素无关。
