Emergency and Critical Care Medical Center, Osaka Police Hospital, Kitayama-cho, 10-31 Tennouji-ku, 543-0035 Osaka, Japan.
Resuscitation. 2010 May;81(5):549-54. doi: 10.1016/j.resuscitation.2010.02.008. Epub 2010 Mar 19.
Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise.
Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH).
Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC< or =2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC.
10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P<0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P<0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P=0.554].
Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.
复苏后治疗已成为院外心脏骤停（OHCA）患者生存的重要预测因素。在日本，根据其能力和专业知识，选定的医院被认证为重症监护医疗中心（CCMC）。
与非重症监护医院（NCCH）相比，送往 CCMC 的 OHCA 患者的预后更好。
2005 年 1 月 1 日至 2007 年 12 月 31 日，使用前瞻性乌斯丁样式人群队列数据库，对大阪由急救医疗服务系统治疗的推定心源性 OHCA 成年患者进行登记。主要结局指标为 1 个月时神经功能良好的存活率（CPC<或=2）。使用多项逻辑回归和基于分层现场 ROSC 的分层比较送往 CCMC 的患者与送往 NCCH 的患者的结局。
共转运 10383 例患者。其中，2881 例转运至 CCMC，7502 例转运至 NCCH。CCMC 组 1 个月时神经功能良好的存活率较高[6.7%对 2.8%，P<0.001]。在未发生现场 ROSC 而转运至医院的患者中，CCMC 组的神经功能良好结局优于 NCCH 组[1.7%对 0.5%；调整后的优势比（OR），3.39；95%置信区间（CI），2.17-5.29；P<0.001]。在存在现场 ROSC 的情况下，两组之间的存活率相似[43%对 41%；调整后的 OR，1.09；95%CI，0.82-1.45；P=0.554]。
送往 CCMC 的推定心源性 OHCA 患者的存活率好于送往 NCCH 的患者。对于无现场 ROSC 的 OHCA 患者，转运至 CCMC 是良好神经结局的独立预测因素。
