Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.
Eur Heart J. 2013 Dec;34(47):3632-40. doi: 10.1093/eurheartj/eht282. Epub 2013 Aug 4.
Characteristics of sudden cardiac arrest (SCA) during sports offers a novel (and unexplored) setting to assess factors associated with disparities in outcomes across regions.
From a prospective 5-year community-based French registry concerning SCA during sports in 10-75 year-olds, we evaluated whether outcomes differed significantly between geographic regions. We then determined the extent to which variations in community-related early interventions were associated with regional variations in survival. Among 820 SCA cases studied, overall survival at hospital discharge was 15.7% (95% confidence interval, 13.2-18.2%), with considerable regional disparities (from 3.4 to 42.6%, P < 0.001). Major differences were noted regarding bystander initiation of cardiopulmonary resuscitation (15.3-80.9%, P < 0.001) and presence of initial shockable rhythm (28.6-79.1%, P < 0.001), with higher values of these being associated with better survival rates. The proportion of survivors with favourable neurological outcome at discharge was fairly uniform among survival groups (CPC-1/2, varying from 77.4 to 90.0%, P = 0.83). No difference was observed regarding subjects' characteristics and circumstances of SCA occurrence, including delays in resuscitation (collapse-to-call period). With a comparable in-hospital mortality (P = 0.44), survival at hospital discharge was highly correlated with that at hospital admission (regional variations from 7.4 to 75.0%, P < 0.001).
Major regional disparities exist in survival rates (up to 10-fold) after SCA during sports. SCA cases from regions with the highest levels of bystander resuscitation had the best survival rates to hospital admission and discharge.
研究运动性心搏骤停（SCA）的特点为评估与区域间结局差异相关的因素提供了一个新颖（且尚未探索）的环境。
从一项为期 5 年的前瞻性法国社区注册研究中，我们评估了在 10-75 岁人群中运动性 SCA 的地理区域之间的结局是否存在显著差异。然后，我们确定了社区相关早期干预措施的差异与生存率的区域差异之间的关联程度。在 820 例 SCA 病例中，住院期间的总体生存率为 15.7%（95%置信区间，13.2-18.2%），存在明显的区域差异（从 3.4%到 42.6%，P<0.001）。在旁观者启动心肺复苏术（15.3-80.9%，P<0.001）和初始可除颤节律的存在（28.6-79.1%，P<0.001）方面存在较大差异，这些因素的发生率越高，生存率越高。出院时具有良好神经功能结局的幸存者比例在生存率组之间相当一致（CPC-1/2，从 77.4%到 90.0%，P=0.83）。在 SCA 发生的情况下，包括复苏延迟（从心搏骤停到呼救的时间），在患者特征和情况下未观察到差异。住院期间死亡率相当（P=0.44），出院时的生存率与入院时的生存率高度相关（从区域差异 7.4%到 75.0%，P<0.001）。
运动性 SCA 后生存率（高达 10 倍）存在显著的区域差异。具有最高旁观者复苏水平的区域中的 SCA 病例，在入院和出院时的生存率最高。
