院外心脏骤停位置对生存结局的影响。

Effect of location of out-of-hospital cardiac arrest on survival outcomes.

机构信息

Department of Acute Care and Emergency, Khoo Teck Puat Hospital, Singapore.

出版信息

Ann Acad Med Singap. 2013 Sep;42(9):437-44.

Abstract

INTRODUCTION

This study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes.

MATERIALS AND METHODS

A retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of- hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI).

RESULTS

A total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas-1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 - 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 - 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 - 11.97]) and initial shockable rhythms (OR 6.78 [1.95 - 23.53]) gave rise to better outcomes.

CONCLUSION

Efforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times.

摘要

简介

本研究旨在探讨新加坡住宅和非住宅地区内，心脏骤停患者的发病位置与某些生存结果之间的关系。

材料与方法

对心脏骤停和复苏流行病学（CARE）项目的数据进行回顾性队列研究。使用 2001 年 10 月至 2004 年 10 月（CARE）的院外心脏骤停（OHCA）数据。所有被确认为无脉搏、无反应和无呼吸的 OHCA 患者均包括在内。所有事件均发生在新加坡。分析结果以比值比（OR）和相应的 95%置信区间（CI）表示。

结果

共使用了 2375 例病例进行分析。住宅区内 OHCA 的结果比非住宅区差——1638 例（68.9%）患者在住宅区发病，仅有 14 例（0.9%）存活至出院。这显著低于非住宅区发病后存活的 2.7%的患者（OR 0.31 [0.16 - 0.62]）。多变量逻辑回归分析表明，位置本身对生存没有独立影响（调整后的 OR 1.13 [0.32 - 4.05]）；相反，旁观者 CPR（OR 3.67 [1.13 - 11.97]）和初始可除颤节律（OR 6.78 [1.95 - 23.53]）等基础因素导致了更好的结果。