Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ward, Kyoto, Japan.
Prehosp Emerg Care. 2011 Apr-Jun;15(2):271-7. doi: 10.3109/10903127.2010.545475.
Research in 2008 demonstrated that the majority of out-of-hospital cardiac arrests (OHCAs) occur in the home, and many important characteristics differ between private and public locations. However, the influence of the location of collapse on survival from OHCA is not well understood. Furthermore, most of the reports have been from Western countries; there is little research from Asia that differentiates the conditions of OHCA.
To investigate the influence of the location of collapse on being discharged alive from OHCA and whether the location of collapse is also an independent predictor of survival from OHCA in Japan.
We analyzed 463 consecutive cases of witnessed OHCA with cardiac etiology that occurred between October 2004 and September 2008 in Japan. We investigated the characteristics of OHCA patients who collapsed in private and public locations, and assessed the influence of the location of collapse on survival from OHCA.
Patients who collapsed outside the home were younger, more likely to be male, more likely to receive bystander cardiopulmonary resuscitation (CPR), and more likely to have ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) and had a shorter time interval between collapse and 9-1-1 call than patients who collapsed in the home. Mortality was significantly higher in the group who collapsed in the home. The independent influence of the location of collapse was eliminated by additional adjustment for time interval from collapse to 9-1-1 call, age, bystander CPR, and initial cardiac rhythm. Finally, VF/pulseless VT as the initial rhythm and bystander CPR were independently associated with the patient's being discharged alive; the location of collapse was not an independently associated variable.
The present analysis demonstrated that there were significant differences in survival between groups of patients who suffered from cardiac arrest inside and outside the home in Japan. The outside-the-home group had a higher rate of survival from OHCA; however, the location of collapse was not an independent predictor of survival from OHCA. Education of the families of high-risk patients in placing a rapid emergency call and performing effective CPR might be needed to improve survival from cardiac arrest in the home.
2008 年的研究表明，大多数院外心脏骤停（OHCA）发生在家庭中，私人和公共场所之间存在许多重要的特征差异。然而，心脏骤停发作地点对 OHCA 存活的影响尚未得到很好的理解。此外，大多数报告来自西方国家，来自亚洲的研究区分 OHCA 条件的很少。
调查心脏骤停发作地点对 OHCA 存活出院的影响，以及在日本，心脏骤停发作地点是否也是 OHCA 存活的独立预测因素。
我们分析了 2004 年 10 月至 2008 年 9 月期间在日本连续发生的 463 例有目击证人的心脏病因所致 OHCA 患者。我们调查了在私人和公共场所发生心脏骤停的患者的特征，并评估了心脏骤停发作地点对 OHCA 存活的影响。
在家外发生心脏骤停的患者更年轻，更可能是男性，更可能接受旁观者心肺复苏（CPR），更可能出现室颤（VF）/无脉性室性心动过速（VT），并且从心脏骤停发作到拨打 9-1-1 的时间间隔更短。在家中发生心脏骤停的患者死亡率明显更高。通过进一步调整从心脏骤停发作到拨打 9-1-1 的时间间隔、年龄、旁观者 CPR 和初始心搏节律，消除了心脏骤停发作地点的独立影响。最后，VF/无脉性 VT 作为初始节律和旁观者 CPR 与患者存活出院独立相关；心脏骤停发作地点不是独立相关变量。
本分析表明，日本在家和在家外发生心脏骤停的患者之间的存活存在显著差异。家庭外组的 OHCA 存活率更高；然而，心脏骤停发作地点不是 OHCA 存活的独立预测因素。可能需要对高危患者的家属进行教育，使其快速紧急呼救并进行有效的 CPR，以提高家庭心脏骤停的存活率。
