Callaway Clifton W, Schmicker Robert, Kampmeyer Mitch, Powell Judy, Rea Tom D, Daya Mohamud R, Aufderheide Thomas P, Davis Daniel P, Rittenberger Jon C, Idris Ahamed H, Nichol Graham
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Resuscitation. 2010 May;81(5):524-9. doi: 10.1016/j.resuscitation.2009.12.006. Epub 2010 Jan 13.
Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases.
Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died > or =1 day later.
A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% vs. 27%, p=0.001), and in hospitals that received > or =40 patients/year compared to those that received <40 (37% vs. 30%, p=0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for surviving subjects was shorter at hospitals performing cardiac catheterization (p<0.01). After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics.
Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome.
院外心脏骤停（OOHCA）后的生存率在不同地区存在差异，但不同因素对这种差异的影响尚不清楚。本研究旨在探讨出院生存率是否与接收医院的特征有关，包括床位数、进行心脏导管插入术的能力以及医院OOHCA病例数量。
2005年12月1日至2007年7月1日期间，在美国8个和加拿大2个地点创建了由紧急医疗服务评估的非创伤性OOHCA前瞻性观察数据库。OOHCA后接受医院治疗的受试者定义为：（1）到达医院时仍有脉搏；或（2）到达医院时无脉搏，但在1天及以后出院或死亡。
共有4087例OOHCA受试者在254家医院接受治疗，32%存活至出院。大多数受试者（68%）在116家（46%）能够进行心脏导管插入术的医院接受治疗。进行心脏导管插入术的医院未经调整的出院生存率更高（34%对27%，p = 0.001），每年接收≥40例患者的医院与接收<40例患者的医院相比，生存率也更高（37%对30%，p = 0.01）。生存率与医院床位数、教学状况或创伤中心指定无关。进行心脏导管插入术的医院中，存活受试者的住院时间（LOS）较短（p<0.01）。在对所有变量进行调整后，生存率或LOS与医院特征之间不存在独立关联。
部分医院亚组对OOHCA受试者显示出更高的生存率和更短的LOS，但医院特征与结局之间不存在独立关联。
