Ambulance Victoria, Australia.
Resuscitation. 2011 Oct;82(10):1302-6. doi: 10.1016/j.resuscitation.2011.05.031. Epub 2011 Jun 15.
We aim to describe the coronial findings of young adults where the out-of-hospital cardiac arrest (OHCA) aetiology was 'presumed cardiac'.
Presumed cardiac aetiology OHCAs occurring in young adults aged 16-39 years were identified using the Victorian Ambulance Cardiac Arrest Registry (VACAR) and available coronial findings reviewed.
We identified 841 young adult OHCAs where the Utstein aetiology was 'presumed cardiac'. Of these 740 died and 572 (77%) OHCAs were matched to coroner's findings. On review of the coroner's cause of death, 230 (40.2%) had a 'confirmed cardiac' aetiology, 221 (38.6%) were proven 'non-cardiac', 97 (17%) were inconclusive and 24 (4.2%) cases remained 'open'. 'Confirmed cardiac' causes of OHCA were ischemic heart disease (n=126, 55%), cardiomegaly (n=26, 11.3%), cardiomyopathy (n=25, 11%), congenital heart disease (n=15, 6.5%), cardiac tamponade due to dissecting thoracic aorta aneurysm (n=10, 4.3%), myocarditis (n=8, 3.5%), arrhythmia (n=7, 3%), others (n=13, 5.7%). 'Non-cardiac' causes of OHCA were epilepsy/sudden unexplained death in epilepsy (SUDEP) (n=56, 25%), pulmonary embolism (n=29, 13%), subarachnoid haemorrhage (n=17, 7.7%), other intracranial bleed (n=7, 3.2%), pneumonia (n=17, 7.7%), DKA (n=16, 7.2%), other complications of diabetes mellitus (n=8, 3.6%), complications of obesity (n=9, 4%), haemorrhage (n=12, 5.4%), sepsis (n=8, 3.6%), peritonitis (n=6, 2.7%), aspiration (n=6, 2.7%), renal failure (n=5, 2.3%), asthma (n=5, 2.3%), complications of anorexia (n=3) and alcohol abuse (n=2), thyrotoxicosis (n=2), meningitis (n=1) and others (n=12). Compared with coroner's diagnosed 'non-cardiac' OHCAs, 'confirmed cardiac' were more likely to be witnessed (41% vs 23%, p≤0.01), receive bystander CPR (35% vs 20%, p≤0.001), have a shockable rhythm (27% vs 6.3%, p<0.001) and have EMS attempted resuscitation (62% vs 44%, p<0.001).
Linking OHCA registries with coronial databases for aetiology of the arrest will improve the quality of the data and should be considered by all OHCA registries, particularly for young adult OHCA.
本研究旨在描述院外心脏骤停（OHCA）病因学为“推测性心源性”的年轻成年人的尸检结果。
使用维多利亚救护车心脏骤停登记处（VACAR）确定年龄在 16-39 岁的年轻成年人的推测性心源性 OHCA，并对可用的尸检结果进行回顾。
我们确定了 841 例年轻成年人 OHCA，其 Utstein 病因学为“推测性心源性”。在这些人中，740 人死亡，572 人（77%）的 OHCA 与验尸官的发现相匹配。在审查验尸官的死因时，230 人（40.2%）有“明确的心源性”病因，221 人（38.6%）被证实为“非心源性”，97 人（17%）不确定，24 人（4.2%）为“开放性”。OHCA 的“明确心源性”病因包括缺血性心脏病（n=126，55%）、心肌肥大（n=26，11.3%）、心肌病（n=25，11%）、先天性心脏病（n=15，6.5%）、因胸主动脉夹层动脉瘤引起的心包填塞（n=10，4.3%）、心肌炎（n=8，3.5%）、心律失常（n=7，3%）、其他（n=13，5.7%）。OHCA 的“非心源性”病因包括癫痫/癫痫猝死（SUDEP）（n=56，25%）、肺栓塞（n=29，13%）、蛛网膜下腔出血（n=17，7.7%）、其他颅内出血（n=7，3.2%）、肺炎（n=17，7.7%）、糖尿病酮症酸中毒（DKA）（n=16，7.2%）、糖尿病并发症（n=8，3.6%）、肥胖并发症（n=9，4%）、出血（n=12，5.4%）、败血症（n=8，3.6%）、腹膜炎（n=6，2.7%）、吸入（n=6，2.7%）、肾衰竭（n=5，2.3%）、哮喘（n=5，2.3%）、厌食症并发症（n=3）和酒精滥用（n=2）、甲状腺毒症（n=2）、脑膜炎（n=1）和其他（n=12）。与验尸官诊断的“非心源性”OHCA 相比，“明确心源性”OHCA 更有可能被目击（41%比 23%，p≤0.01）、接受旁观者心肺复苏（35%比 20%，p≤0.001）、有可除颤节律（27%比 6.3%，p<0.001）和接受急救人员复苏尝试（62%比 44%，p<0.001）。
将 OHCA 登记处与尸检病因数据库联系起来，将提高数据的质量，所有 OHCA 登记处都应考虑这样做，特别是对年轻成年人 OHCA。
