Alfred Hospital Heart Centre, Melbourne, Victoria, Australia.
Am J Cardiol. 2011 Feb 15;107(4):522-7. doi: 10.1016/j.amjcard.2010.10.011. Epub 2010 Dec 22.
Survival rates after out-of-hospital cardiac arrest (OHCA) continue to be poor. Recent evidence suggests that a more aggressive approach to postresuscitation care, in particular combining therapeutic hypothermia with early coronary intervention, can improve prognosis. We performed a single-center review of 125 patients who were resuscitated from OHCA in 2 distinct treatment periods, from 2002 to 2003 (control group) and from 2007 to 2009 (contemporary group). Patients in the contemporary group had a higher prevalence of cardiovascular risk factors but similar cardiac arrest duration and prehospital treatment (adrenaline administration and direct cardioversion). Rates of cardiogenic shock (48% vs 41%, p = 0.2) and decreased conscious state on arrival (77% vs 86%, p = 0.2) were similar in the 2 cohorts, as was the incidence of ST-elevation myocardial infarction (33% vs 43%, p = 0.1). The contemporary cohort was more likely to receive therapeutic hypothermia (75% vs 0%, p <0.01), coronary angiography (77% vs 45%, p <0.01), and percutaneous coronary intervention (38% vs 23%, p = 0.03). This contemporary therapeutic strategy was associated with better survival to discharge (64% vs 39%, p <0.01) and improved neurologic recovery (57% vs 29%, p <0.01) and was the only independent predictor of survival (odds ratio 5.5, 95% confidence interval 1.2 to 26.2, p = 0.03). Longer resuscitation time, presence of cardiogenic shock, and decreased conscious state were independent predictors of poor outcomes. In conclusion, modern management of OHCA, including therapeutic hypothermia and early coronary angiography is associated with significant improvement in survival to hospital discharge and neurologic recovery.
院外心脏骤停（OHCA）后的存活率仍然很低。最近的证据表明，更积极的复苏后治疗方法，特别是将治疗性低温与早期冠状动脉介入相结合，可以改善预后。我们对在两个不同治疗时期（2002 年至 2003 年为对照组，2007 年至 2009 年为当代组）从 OHCA 中复苏的 125 名患者进行了单中心回顾。当代组的心血管危险因素患病率较高，但心脏骤停持续时间和院前治疗（肾上腺素给药和直接电复律）相似。两组患者心源性休克发生率（48%比 41%，p=0.2）和入院时意识状态下降率（77%比 86%，p=0.2）相似，ST 段抬高型心肌梗死发生率也相似（33%比 43%，p=0.1）。当代组更有可能接受治疗性低温（75%比 0%，p<0.01）、冠状动脉造影（77%比 45%，p<0.01）和经皮冠状动脉介入治疗（38%比 23%，p=0.03）。这种当代治疗策略与出院时存活率的提高相关（64%比 39%，p<0.01）和神经功能恢复的改善（57%比 29%，p<0.01），并且是存活的唯一独立预测因素（优势比 5.5，95%置信区间 1.2 至 26.2，p=0.03）。较长的复苏时间、心源性休克的存在和意识状态的下降是不良预后的独立预测因素。总之，OHCA 的现代管理方法，包括治疗性低温和早期冠状动脉造影，与出院时生存率和神经功能恢复的显著改善相关。
