澳大利亚墨尔本院外创伤性心搏骤停。
Traumatic out-of-hospital cardiac arrests in Melbourne, Australia.
机构信息
Ambulance Victoria, Australia.
出版信息
Resuscitation. 2012 Apr;83(4):465-70. doi: 10.1016/j.resuscitation.2011.09.025. Epub 2011 Oct 10.
INTRODUCTION
Many consider attempted resuscitation for traumatic out-of-hospital cardiac arrest (OHCA) futile. This study aims to describe the characteristics and profile of adult traumatic OHCA.
METHODS
The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all trauma related cases of OHCA in patients aged ≥16 years.
RESULTS
Between 2000 and 2009, EMS attended 33,178 OHCAs of which 2187 (6.6%) had a traumatic aetiology. The median age (IQR) of traumatic OHCA cases was 36 (25-55) years and 1612 were male (77.5%). Bystander CPR was performed in 201 cases (10.2%) with median (IQR) EMS response time 8 (6-11)min. The first recorded rhythm by EMS was asystole seen in 1650 (75.4%), PEA in 294 (13.4%) cases and VF in 35 cases (1.6%). Cardiac output was present in 208 (9.5%) cases who subsequently had an EMS witnessed OHCA. EMS attempted resuscitation in 545 (24.9%) patients of whom 84 (15.4%) achieved ROSC and were transported, and 27 (5.1%) survived to hospital discharge; 107 were transported with CPR of whom 8 (7.4%) survived to hospital discharge. Where EMS attempted resuscitation in traumatic OHCAs, survival for VF was 11.8% (n=4), PEA 5.1% (n=10) and asystole 2.4% (n=3). In EMS witnessed traumatic OHCA, resuscitation was attempted in 175 cases (84.1%), 35 (16.8%) patients achieved sustained ROSC before transport of whom 5 (14%) survived to leave hospital and 60 (28.8%) were transported with CPR of whom 6 (10%) survived to leave hospital. Compared to OHCA cases with 'presumed cardiac' aetiology traumatic OHCAs were younger [median years (IQR): 36 (25-55) vs 74 (61-82)], had resuscitation attempted less (25% vs 48%), were less likely to have a shockable rhythm (1.6% vs 17.1%), were more likely to be witnessed (62.8% vs 38.1%) and were less likely to receive bystander CPR (10.2% vs 25.5%) (p<0.001, respectively). Multivariate logistic regression identified factors associated with EMS decision to attempt resuscitation. The odds ratio [OR (95% CI)] for 'presence of bystander CPR' was 5.94 (4.11-8.58) and for 'witnessed arrest' was 2.60 (1.86-3.63).
CONCLUSION
In this paramedic delivered EMS attempted resuscitation was not always futile in traumatic OHCA with a survival of 5.1%. The quality of survival needs further study.
简介
许多人认为创伤性院外心脏骤停（OHCA）的复苏尝试是徒劳的。本研究旨在描述成人创伤性 OHCA 的特征和概况。
方法
维多利亚救护车心脏骤停登记处（VACAR）用于确定所有年龄≥16 岁的创伤相关 OHCA 患者的病例。
结果
2000 年至 2009 年，EMS 共处理了 33178 例 OHCA，其中 2187 例（6.6%）为创伤性病因。创伤性 OHCA 病例的中位年龄（IQR）为 36（25-55）岁，1612 例为男性（77.5%）。201 例（10.2%）有旁观者心肺复苏（CPR），中位（IQR）EMS 反应时间为 8（6-11）min。EMS 首次记录的节律为除颤前心律，其中 1650 例（75.4%）为心动过缓，294 例（13.4%）为无脉电活动（PEA），35 例（1.6%）为室颤（VF）。208 例（9.5%）存在心输出量，随后有 EMS 目击 OHCA。EMS 对 545 例（24.9%）患者进行了复苏尝试，其中 84 例（15.4%）实现了自主循环恢复（ROSC）并被转运，27 例（5.1%）存活至出院；107 例在 CPR 下被转运，其中 8 例（7.4%）存活至出院。在创伤性 OHCA 中，EMS 尝试复苏的存活率为 VF 11.8%（n=4）、PEA 5.1%（n=10）和心动过缓 2.4%（n=3）。在 EMS 目击的创伤性 OHCA 中，175 例（84.1%）尝试了复苏，35 例（16.8%）在转运前实现了持续 ROSC，其中 5 例（14%）存活出院，60 例（28.8%）在 CPR 下转运，其中 6 例（10%）存活出院。与“推测为心源性”病因的 OHCA 病例相比，创伤性 OHCA 更年轻[中位数（IQR）：36（25-55）岁 vs 74（61-82）岁]，复苏尝试较少（25% vs 48%），更不可能有可除颤节律（1.6% vs 17.1%），更有可能被目击（62.8% vs 38.1%），更不可能接受旁观者 CPR（10.2% vs 25.5%）（p<0.001）。多变量逻辑回归确定了与 EMS 决定尝试复苏相关的因素。“旁观者 CPR 存在”的比值比（OR（95%CI））为 5.94（4.11-8.58），“目击逮捕”的比值比为 2.60（1.86-3.63）。
结论
在本研究中，在创伤性 OHCA 中，复苏尝试并不总是徒劳的，存活率为 5.1%。生存质量需要进一步研究。
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