Bosson Nichole, Kaji Amy H, Niemann James T, Eckstein Marc, Rashi Paula, Tadeo Richard, Gorospe Deidre, Sung Gene, French William J, Shavelle David, Thomas Joseph L, Koenig William
Prehosp Emerg Care. 2014 Apr-Jun;18(2):217-23. doi: 10.3109/10903127.2013.856507. Epub 2014 Jan 8.
Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). This study describes experience with regionalized care of resuscitated patients.
Los Angeles (LA) County established regionalized cardiac care in 2006. Since 2010, protocols mandate transport of nontraumatic OOHCA patients with field return of spontaneous circulation (ROSC) to a STEMI Receiving Center (SRC) with a hypothermia protocol. All SRC report outcomes to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report the first year's data. The primary outcome was survival with good neurologic outcome, defined by a Cerebral Performance Category (CPC) score of 1 or 2.
The SRC treated 927 patients from April 2011 through March 2012 with median age 67; 38% were female. There were 342 patients (37%) who survived to hospital discharge. CPC scores were unknown in 47 patients. Of the 880 patients with known CPC scores, 197 (22%) survived to hospital discharge with a CPC score of 1 or 2. The initial rhythm was VF/VT in 311 (34%) patients, of whom 275 (88%) were witnessed. For patients with an initial shockable rhythm, 183 (59%) survived to hospital discharge and 120 (41%) had survival with good neurologic outcome. Excluding patients who were alert or died in the ED, 165 (71%) patients with shockable rhythms received therapeutic hypothermia (TH), of whom 67 (42%) had survival with good neurologic outcome. Overall, 387 patients (42%) received TH. In the TH group, the adjusted OR for CPC 1 or 2 was 2.0 (95%CI 1.2-3.5, p = 0.01), compared with no TH. In contrast, the proportion of survival with good neurologic outcome in the City of LA in 2001 for all witnessed arrests (irrespective of field ROSC) with a shockable rhythm was 6%.
We found higher rates of neurologically intact survival from OOHCA in our system after regionalization of post-resuscitation care as compared to historical data.
在专业中心对心脏骤停患者进行复苏后护理可能会改善院外心脏骤停（OOHCA）后的预后。本研究描述了对复苏患者进行区域化护理的经验。
洛杉矶县于2006年建立了区域化心脏护理体系。自2010年起，相关协议规定将现场恢复自主循环（ROSC）的非创伤性OOHCA患者转运至设有亚低温治疗方案的ST段抬高型心肌梗死接收中心（SRC）。所有SRC都要向洛杉矶县紧急医疗服务（EMS）机构维护的登记处报告结果。我们报告第一年的数据。主要结局是具有良好神经功能预后的存活，定义为脑功能分类（CPC）评分为1或2。
SRC在2011年4月至2012年3月期间共治疗了927例患者，中位年龄为67岁；38%为女性。有342例患者（37%）存活至出院。47例患者的CPC评分未知。在880例已知CPC评分的患者中，197例（22%）存活至出院且CPC评分为1或2。初始心律为室颤/室速的患者有311例（34%），其中275例（88%）为目击情况。对于初始可电击心律的患者，183例（59%）存活至出院，120例（41%）存活且具有良好神经功能预后。排除在急诊科时已清醒或死亡的患者，165例（71%）有可电击心律的患者接受了治疗性低温（TH），其中67例（42%）存活且具有良好神经功能预后。总体而言，387例患者（42%）接受了TH。在TH组中，与未接受TH相比，CPC评分为1或2的校正比值比为2.0（95%CI 1.2 - 3.5，p = 0.01）。相比之下，2001年洛杉矶市所有具有可电击心律的目击心脏骤停（无论现场是否恢复自主循环）患者中，具有良好神经功能预后的存活比例为6%。
我们发现，与历史数据相比，在我们的系统中，复苏后护理区域化后，院外心脏骤停患者神经功能完好存活的比例更高。
