Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan.
Resuscitation. 2010 Aug;81(8):956-61. doi: 10.1016/j.resuscitation.2010.04.015.
The increasing survival rates after out-of-hospital cardiac arrests (OHCA) are due mainly to improvements in the first 3 steps of the chain of survival. The aim of this study was to describe the temporal trends of OHCA incidence and outcomes with shock-resistant ventricular fibrillation (VF) requiring advanced life support procedures.
All our subjects were persons aged 18 years or more who had suffered OHCA of presumed cardiac etiology, were witnessed by bystanders, treated by emergency medical service (EMS), and had VF as initial rhythm. Our study was conducted in Osaka Prefecture, Japan from May 1, 1998 through December 31, 2006. Data were collected by EMS personnel using an Utstein-style database. We evaluated the temporal trends of incidence and outcomes of shock-resistant VF.
During the study period, there were 8782 witnessed OHCA cases of presumed cardiac etiology. Among them, 1733 had VF as an initial rhythm, 392 of whom were shock-resistant. While the age-adjusted annual incidence of witnessed VF increased from 2.0 to 3.3 per 100,000 inhabitants, that of shock-resistant VF underwent little change during the study period. The proportion of shock-resistant VF among witnessed VF decreased from 37.0% to 19.0%. Neurologically intact 1-month survival rates after shock-resistant VF remained low at 5.6% even in 2006.
The actual incidence of shock-resistant VF has remained unchanged, and their outcomes continue to be dismal. Further efforts are required to reduce the mortality rates of such shock-resistant VF to achieve improved survival after OHCA.
院外心脏骤停（OHCA）后的生存率提高主要归因于生存链前 3 步的改进。本研究旨在描述需要高级生命支持程序的耐电击性室颤（VF）的 OHCA 发生率和结局的时间趋势。
我们的所有研究对象均为 18 岁或以上的患者，其经历了OHCA，有旁观者目击，接受了紧急医疗服务（EMS）的治疗，并且初始节律为VF。本研究于 1998 年 5 月 1 日至 2006 年 12 月 31 日在日本大阪府进行。数据由 EMS 人员使用乌斯太因（Utstein）风格的数据库收集。我们评估了耐电击性 VF 的发生率和结局的时间趋势。
在研究期间，有 8782 例目击 OHCA 被认为是心脏原因。其中，1733 例有 VF 作为初始节律，392 例为耐电击性 VF。虽然年龄调整后的目击 VF 的年发生率从 2.0 增加到 3.3/10 万人，但耐电击性 VF 的发生率在研究期间几乎没有变化。耐电击性 VF 在目击 VF 中的比例从 37.0%下降到 19.0%。即使在 2006 年，耐电击性 VF 后神经功能完整的 1 个月生存率仍保持在 5.6%的低水平。
耐电击性 VF 的实际发生率保持不变，其结局仍然不佳。需要进一步努力降低此类耐电击性 VF 的死亡率，以提高 OHCA 后的生存率。
