Moriwaki Yoshihiro, Tahara Yoshio, Kosuge Takayuki, Suzuki Noriyuki
Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
J Emerg Trauma Shock. 2013 Apr;6(2):87-94. doi: 10.4103/0974-2700.110752.
The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA) has not been established. We have performed perimortem computed tomography (CT) during cardiopulmonary resuscitation.
To clarify the incidence of non-cardiac etiology (NCE), actual distribution of the causes of OHCPA via perimortem CT and its usefulness.
Population-based observational case series study.
We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding) and others.
Of a total OHCPA, perimortem CT was performed in 57.5% and 62.5% were finally diagnosed as NCE: Acute aortic dissection (AAD) 8.07%, pulmonary thrombo-embolization (PTE) 1.46%, hypoxia due to pneumonia 5.25%, asthma and acute worsening of chronic obstructive pulmonary disease 2.06%, cerebrovascular disorder (CVD) 4.48%, airway obstruction 7.64%, and submersion 5.63%. The rates of patients who survived to hospital discharge were 6-14% in patients with NCE. Out of the 1476 cases excluding obvious NCE of OHCPA, 66.3% underwent perimortem CT, 14.6% of cases without obvious NCE and 22.1% of cases with perimortem CT were confirmed as having some NCE.
Of the total OHCPA the incidences of NCE was 62.5%; the leading etiologies were AAD, airway obstruction, submersion, hypoxia and CVD. The rates of cases converted from cardiac etiology to NCE using perimortem CT were 14.6% of cases without an obvious NCE.
院外心脏骤停（OHCPA）的病因谱尚未明确。我们在心肺复苏期间进行了濒死期计算机断层扫描（CT）。
通过濒死期CT明确非心脏病因（NCE）的发生率、OHCPA病因的实际分布情况及其效用。
基于人群的观察性病例系列研究。
我们回顾了1846例连续的OHCPA病例的病历，并将其分为两组：370例显示OHCPA有明显病因且为NCE（创伤、缢颈、恶性肿瘤终末期和胃肠道出血）以及其他病例。
在所有OHCPA病例中，57.5%进行了濒死期CT检查，最终62.5%被诊断为NCE：急性主动脉夹层（AAD）8.07%、肺血栓栓塞（PTE）1.46%、肺炎导致的缺氧5.25%、哮喘和慢性阻塞性肺疾病急性加重2.06%、脑血管疾病（CVD）4.48%、气道阻塞7.64%、溺水5.63%。NCE患者出院存活率为6 - 14%。在排除OHCPA明显NCE的1476例病例中，66.3%进行了濒死期CT检查，无明显NCE病例中的14.6%以及进行濒死期CT检查病例中的22.1%被确认为存在某种NCE。
在所有OHCPA病例中，NCE的发生率为62.5%；主要病因是AAD、气道阻塞、溺水、缺氧和CVD。使用濒死期CT从心脏病因转变为NCE的病例比例在无明显NCE的病例中为14.6%。
