Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Resuscitation. 2013 Feb;84(2):162-7. doi: 10.1016/j.resuscitation.2012.06.029. Epub 2012 Jul 13.
Out-of-hospital cardiac arrest (OHCA) has been reported to carry very varying morbidity and mortality. However, it remains unclear whether this is caused by intrinsic factors of the OHCA or due to the level of in-hospital care. The aim of this study is to compare 30-day and long-term mortality after OHCA at tertiary heart centres and non-tertiary university hospitals.
Data from the Copenhagen OHCA registry from June 2002 through December 2010 included a total of 1218 consecutive patients treated by the same mobile emergency care unit (MECU) with either return of spontaneous circulation (ROSC) or on-going resuscitation (n=53) at hospital arrival. The MECU transported patients to the nearest hospital unless an ECG on scene suggested ST-segment elevation myocardial infarction, in which case patients were transported to the nearest tertiary centre for acute coronary angiography. Therefore, patients with ST-elevation myocardial infarction (n=198) were excluded from the analysis. 30-day mortality was 56% vs. 76% and long term (up to 8years) mortality was 78% vs. 94% for tertiary and non-tertiary hospitals, respectively, both p<0.001. Multivariate analysis showed that admission to a non-tertiary hospital was independently associated with increased risk of death (HR=1.32, 95% CI: 1.09-1.59, p=0.004). Exclusion of patients with on-going resuscitation at admission resulted in HR=1.34 (1.11-1.62), p=0.003. A matched pair propensity score analysis of 255 patients confirmed the results of the proportional hazard analysis (HR=1.35, 95% CI: 1.11-1.65 p=0.003).
Admission to tertiary centres is associated with lower mortality rates after OHCA compared with non-tertiary hospitals.
院外心脏骤停（OHCA）的发病率和死亡率差异很大。然而，目前尚不清楚这是由 OHCA 的内在因素引起的，还是由院内治疗水平引起的。本研究旨在比较三级心脏中心和非三级大学医院 OHCA 后的 30 天和长期死亡率。
本研究的数据来自 2002 年 6 月至 2010 年 12 月哥本哈根 OHCA 登记处，共包括 1218 例由同一移动急救单元（MECU）治疗的连续患者，这些患者在到达医院时要么出现自主循环恢复（ROSC），要么持续复苏（n=53）。除非现场心电图提示 ST 段抬高型心肌梗死，否则 MECU 将患者转运至最近的医院，在这种情况下，患者将被转运至最近的三级中心进行急性冠状动脉造影。因此，本研究排除了 ST 段抬高型心肌梗死患者（n=198）。30 天死亡率分别为 56%和 76%，长期（最长 8 年）死亡率分别为 78%和 94%，三级和非三级医院之间差异均有统计学意义（均 P<0.001）。多变量分析显示，入住非三级医院与死亡风险增加独立相关（HR=1.32，95%CI：1.09-1.59，P=0.004）。排除入院时持续复苏的患者后，HR=1.34（1.11-1.62），P=0.003。对 255 例患者进行匹配对倾向评分分析，结果证实了比例风险分析的结果（HR=1.35，95%CI：1.11-1.65，P=0.003）。
与非三级医院相比，入住三级中心与 OHCA 后死亡率降低相关。
