Fabbri Andrea, Marchesini Giulio, Spada Marco, Iervese Tiziana, Dente Massimo, Galvani Marcello, Vandelli Alberto
Dipartimento dell'Emergenza, Azienda USL Forlì, Italy.
Resuscitation. 2006 Nov;71(2):180-7. doi: 10.1016/j.resuscitation.2006.04.003. Epub 2006 Sep 18.
Only a few data are available on the survival rate following out-of-hospital cardiac arrest in different Italian settings. We report an analysis of a 10-year experience in a mixed rural/urban setting, the main variables associated with survival, and the preliminary results of the implementation of an automated external defibrillator (AED) programme operated by lay volunteers on the effectiveness of the existing Emergency Medical Service (EMS).
We report data from an observational cohort study on all adults, resuscitated from witnessed cardiac arrest between 1994 and 2004 in the district area of Forlì (Italy). The AED programme was introduced in 2002. Entry variables, time intervals and nodal events were tested according to Utstein recommendations. The predictors of favourable outcomes (Overall Performance Category 1-2) were identified by logistic regression analysis.
The witnessed cardiac arrest rate was 27/100,000 population per year (95% confidence interval, 18-38). The initial rhythm was shockable in 241/479 cases (50.3%). After resuscitation, 55 (11.5%) subjects had a favourable outcome at discharge and 38 (7.9%) at 1 year. Time-to-treatment was longer for EMS than for AED-equipped units (median, 8 min interquartile range, 6-10 (467 cases) versus 6 min interquartile range, 4-8 (13 cases); P<0.013), but the final results of the AED programme were poor, with only 1 subject saved/171,000 inhabitants in 2 years. Positive outcome predictors were male sex, younger age, shockable rhythms, low number of defibrillations, and no history of hypertension, diabetes, myocardial infarction or congestive heart failure.
Even in a mixed urban/rural setting, survival from out-of-hospital cardiac arrest is dependent on well-known predictors. In our setting, the number of cases saved by an AED programme is limited when accompanied by an efficient traditional EMS. The allocation of resources to an AED programme should be reconsidered in a mixed rural/urban setting.
关于意大利不同地区院外心脏骤停后的生存率，仅有少量数据。我们报告了在一个城乡结合地区的10年经验分析、与生存相关的主要变量，以及由非专业志愿者操作的自动体外除颤器（AED）项目对现有紧急医疗服务（EMS）有效性的初步实施结果。
我们报告了一项观察性队列研究的数据，该研究针对1994年至2004年间在意大利弗利地区从目击心脏骤停中复苏的所有成年人。AED项目于2002年引入。根据乌斯坦因建议对入院变量、时间间隔和节点事件进行了测试。通过逻辑回归分析确定了良好结局（总体表现类别1 - 2）的预测因素。
目击心脏骤停发生率为每年27/10万人口（95%置信区间，18 - 38）。241/479例（50.3%）患者的初始心律为可电击心律。复苏后，55例（11.5%）患者出院时结局良好，38例（7.9%）患者1年后结局良好。EMS的治疗时间比配备AED的单位更长（中位数，四分位间距8分钟，6 - 10分钟（467例）对四分位间距6分钟，4 - 8分钟（13例）；P<0.013），但AED项目的最终结果不佳，2年内每17.1万居民仅挽救1例患者。良好结局的预测因素为男性、年龄较小、可电击心律、较少的除颤次数，以及无高血压、糖尿病、心肌梗死或充血性心力衰竭病史。
即使在城乡结合地区，院外心脏骤停的生存也取决于众所周知的预测因素。在我们的地区，当有高效的传统EMS时，AED项目挽救的病例数有限。在城乡结合地区应重新考虑AED项目的资源分配。
