Liu J Marc, Yang Qing, Pirrallo Ronald G, Klein John P, Aufderheide Tom P
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Prehosp Emerg Care. 2008 Jul-Sep;12(3):339-46. doi: 10.1080/10903120802101330.
Previous literature has identified patient and emergency medical services (EMS) system factors that are associated with survival of out-of-hospital cardiac arrest patients.
To determine variability in rates of survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients and to identify hospital-related factors associated with survival.
This was a retrospective, observational study of all adult (21 years or older) out-of-hospital Utstein criteria cardiac-etiology arrests treated by Milwaukee County EMS during the period 1995-2005 and surviving to hospital intensive care unit admission. The primary outcome measure was survival to hospital discharge. Logistic regression analysis was used to compare the odds of survival between hospitals, patient factors, and hospital factors.
1,702 patients at eight receiving hospitals were included in the study analyses. Hospital survival rates ranged from 29% to 42%. Patient and case factors associated with increased survival included younger age, male gender, nonwhite race, witnessed arrest in a public location, bystander cardiopulmonary resuscitation (CPR), a modest number of defibrillations, and initial cardiac rhythm of ventricular tachycardia. The only hospital characteristic correlated with survival was the number of beds per nurse. Patients admitted to a hospital with a ratio of beds to nurse less than 1.0 were over 1.5 times more likely to survive.
Survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients may vary by receiving hospital. A hospital's ratio of beds to nurse and several patient/case f actors are correlated with survival. Further research is warranted to investigate how this may affect resuscitation care, EMS transport policy, and research design.
既往文献已确定了与院外心脏骤停患者生存相关的患者及紧急医疗服务（EMS）系统因素。
确定复苏成功的成年院外心脏骤停患者出院生存率的差异，并识别与生存相关的医院因素。
这是一项回顾性观察研究，研究对象为1995年至2005年期间由密尔沃基县紧急医疗服务部门治疗并存活至医院重症监护病房入院的所有成年（21岁及以上）院外符合Utstein标准的心脏病因性骤停患者。主要结局指标是出院生存率。采用逻辑回归分析比较不同医院、患者因素和医院因素之间的生存几率。
八家接收医院的1702例患者纳入研究分析。医院生存率在29%至42%之间。与生存率增加相关的患者及病例因素包括年龄较小、男性、非白人种族、在公共场所发生的目击骤停、旁观者心肺复苏（CPR）、适度的除颤次数以及初始心律为室性心动过速。与生存相关的唯一医院特征是每名护士配备的床位数。入住床位与护士比例小于1.0的医院的患者存活可能性高出1.5倍以上。
复苏成功的成年院外心脏骤停患者的出院生存率可能因接收医院而异。医院的床位与护士比例以及若干患者/病例因素与生存相关。有必要进一步研究这可能如何影响复苏护理、紧急医疗服务转运政策和研究设计。
