Department of Medicine, University of Washington, 401 5th Avenue, Seattle, WA, USA.
Ann Emerg Med. 2010 Mar;55(3):249-57. doi: 10.1016/j.annemergmed.2009.09.018. Epub 2009 Nov 27.
Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences.
We used an observational, prospective data collection, case-series of adult persons with nontraumatic out-of-hospital cardiac arrest from December 1, 2005, through March 1, 2007, from the multisite, population-based Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. We used logistic regression, receiver operating curves, and measures of variance to estimate the extent to which the Utstein elements predicted survival to hospital discharge and explained outcome variability overall and between 7 Resuscitation Outcomes Consortium sites. Analyses were conducted for all emergency medical services-treated cardiac arrests and for the subset of bystander-witnessed patient arrests because of presumed cardiac cause presenting with ventricular fibrillation or ventricular tachycardia.
Survival was 7.8% overall (n=833/10,681) and varied from 4.6% to 14.7% across Resuscitation Outcomes Consortium sites. Among bystander-witnessed ventricular fibrillation or ventricular tachycardia, survival was 22.1% overall (n=323/1459) and varied from 12.5% to 41.0% across sites. The Utstein elements collectively predicted 72% of survival variability among all arrests and 40% of survival variability among bystander-witnessed ventricular fibrillation. The Utstein elements accounted for 43.6% of the between-site survival difference among all arrests and 22.3% of the between-site difference among the bystander-witnessed ventricular fibrillation subset.
The Utstein elements predict survival but account for only a modest portion of outcome variability overall and between Resuscitation Outcomes Consortium sites. The results underscore the need for ongoing investigation to better understand characteristics that influence cardiac arrest survival.
院外心脏骤停患者的存活率取决于生存链中的各个环节。乌斯泰因要素旨在评估这些环节，并为比较社区内和社区间的结果提供基础。我们评估这些措施是否足以预测存活率并解释结果差异。
我们使用观察性、前瞻性数据收集，对 2005 年 12 月 1 日至 2007 年 3 月 1 日期间来自多站点、基于人群的复苏结果联盟复苏结果登记处的非创伤性院外心脏骤停成年患者进行病例系列观察。我们使用逻辑回归、接收者操作曲线和方差度量来估计乌斯泰因要素预测存活率至出院的程度，以及解释总体结果和 7 个复苏结果联盟站点之间结果变异性的程度。对所有急救医疗服务治疗的心脏骤停和假定心脏原因导致的旁观者目击患者心脏骤停亚组（表现为心室颤动或室性心动过速）进行了分析。
总体存活率为 7.8%（n=833/10681），复苏结果联盟各站点之间的存活率从 4.6%到 14.7%不等。在旁观者目击的心室颤动或室性心动过速中，总体存活率为 22.1%（n=323/1459），各站点之间的存活率从 12.5%到 41.0%不等。乌斯泰因要素总体上预测了所有心脏骤停患者存活率变化的 72%，预测了旁观者目击的心室颤动患者存活率变化的 40%。乌斯泰因要素占所有心脏骤停患者之间站点存活率差异的 43.6%，占旁观者目击的心室颤动亚组之间站点差异的 22.3%。
乌斯泰因要素可以预测存活率，但仅占总体和复苏结果联盟各站点之间结果变异性的一小部分。研究结果强调需要持续进行研究，以更好地了解影响心脏骤停存活率的特征。
