Institute for Experimental Medical Research, Oslo University Hospital Ulleval, N-0407 Oslo, Norway.
Resuscitation. 2010 Apr;81(4):422-6. doi: 10.1016/j.resuscitation.2009.12.020. Epub 2010 Feb 1.
Survival after out-of-hospital cardiac arrest (OHCA) depends on a well functioning Chain of Survival. We wanted to assess if targeted attempts to strengthen the weak links of our local chain; quality of advanced life support (ALS) and post-resuscitation care, would improve outcome.
Utstein data from all OHCAs in Oslo during three distinct 2-year time periods 1996-1998, 2001-2003 and 2004-2005 were collected. Before the second period the local ALS guidelines changed with increased focus on good quality chest compressions with minimal pauses, while standardized post-resuscitation care including goal directed therapy with therapeutic hypothermia and percutaneous coronary intervention was added in the third period. Additional a priori sub-group analyses of arrests with cardiac aetiology as well as bystander witnessed ventricular fibrillation/tachycardia (VF/VT) arrests with cardiac aetiology were performed.
ALS was attempted in 454, 449, and 417 patients with OHCA in the first, second and last time period, respectively. From the first to the third period VF/VT arrests declined (40% vs. 33%, p=0.039) and fewer arrests were witnessed (80% vs. 72%, p=0.022) and response intervals increased (7+/-4 to 9+/-4 min, p<0.001). Overall survival increased from 7% (first period) to 13% (last period), p=0.002, and survival in the sub-group of bystander witnessed VF/VT arrests with cardiac aetiology increased from 15% (first period) to 35% (last period), p=0.001.
Survival after OHCA was increased after improving weak links of our local Chain of Survival, quality of ALS and post-resuscitation care.
院外心脏骤停（OHCA）后的存活率取决于有效的生存链。我们希望评估是否有针对性地加强当地生存链的薄弱环节，即高级生命支持（ALS）和复苏后护理的质量，能够改善预后。
收集了奥斯陆在三个不同的 2 年时间段（1996-1998 年、2001-2003 年和 2004-2005 年）所有 OHCA 的乌斯泰因数据。在第二个时期之前，当地的 ALS 指南发生了变化，重点是高质量的胸外按压，尽量减少暂停，同时在第三个时期增加了标准化的复苏后护理，包括目标导向治疗和低温治疗以及经皮冠状动脉介入治疗。还对具有心脏病因的心脏骤停和旁观者目击的室颤/室速（VF/VT）骤停进行了预先设定的亚组分析。
在第一个、第二个和最后一个时期，尝试 ALS 的 OHCA 患者分别为 454、449 和 417 例。从第一个时期到第三个时期，VF/VT 骤停的比例下降（40%比 33%，p=0.039），目击的骤停比例下降（80%比 72%，p=0.022），反应间隔延长（7+/-4 分钟到 9+/-4 分钟，p<0.001）。总存活率从第一个时期的 7%上升到最后一个时期的 13%（p=0.002），旁观者目击的具有心脏病因的 VF/VT 骤停的存活率从第一个时期的 15%上升到最后一个时期的 35%（p=0.001）。
通过改善当地生存链的薄弱环节，提高 ALS 和复苏后护理的质量，OHCA 后的存活率得到了提高。
