Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France,
Intensive Care Med. 2014 Jun;40(6):846-54. doi: 10.1007/s00134-014-3252-5. Epub 2014 Mar 22.
Sudden cardiac death (SCD) is a major public health concern, but data regarding epidemiology of this disease in Western European countries are outdated. This study reports the first results from a large registry of SCD.
A population-based registry was established in May 2011 using multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Utstein variables were recorded. Pre-hospital and in-hospital data were considered, and the main outcome was survival at hospital discharge. Neurologic status at discharge was established as well.
Of the 6,165 cases of SCD recorded over 2 years, 3,816 had a resuscitation attempt and represent the study population. Most patients were male (69%), the SCD occurred at home (72%) with bystanders in 80% of cases, and cardiopulmonary resuscitation (CPR) was performed in 45% of cases. Initial rhythm was shockable in 26% of cases. A total of 1,332 patients (35%) were admitted alive to hospital. Among hospitalized patients, 58% had a coronary angiogram, and the same proportion had therapeutic hypothermia. Finally, 279 patients (7.5%) were discharged alive, of whom 96% had a favorable neurological outcome. In multivariate analysis, bystander CPR (OR 2.1, 95% CI 1.5-3.1) and initial shockable rhythm (OR 11.5, 95% CI 7.6-17.3) were positively associated with survival at hospital discharge, whereas age (OR 0.97 per year, 95% CI 0.96-0.98), longer response time (OR 0.93 per minute, 95% CI 0.89-0.97), occurrence at home (OR 0.4, 95% CI 0.3-0.6), and epinephrine dose greater than 3 mg (OR 0.05, 95% CI 0.03-0.08) were inversely associated with survival.
Despite being conducted in the therapeutic hypothermia and early coronary angiogram era, hospital discharge survival rate of resuscitated SCD remains poor. The current registry suggests ways to improve pre-hospital and in-hospital care of these patients.
心脏性猝死（SCD）是一个重大的公共卫生问题，但关于西欧国家该病流行病学的数据已经过时。本研究报告了首例大型 SCD 登记研究结果。
2011 年 5 月，使用多种来源建立了一个基于人群的登记处，以收集巴黎及其郊区的每一例 SCD 病例，覆盖人口 660 万。记录了乌斯泰因变量。考虑了院前和院内数据，主要结局是出院时的存活率。还确定了出院时的神经状态。
在 2 年期间记录的 6165 例 SCD 中，有 3816 例进行了复苏尝试，构成了研究人群。大多数患者为男性（69%），SCD 在家中（72%）发生，80%的病例有旁观者在场，45%的病例进行了心肺复苏（CPR）。初始节律为可电击节律的占 26%。共有 1332 名（35%）患者存活入院。在住院患者中，58%接受了冠状动脉造影，相同比例的患者接受了治疗性低温。最后，279 名（7.5%）患者存活出院，其中 96%的患者有良好的神经功能结局。多变量分析显示，旁观者 CPR（OR 2.1，95%CI 1.5-3.1）和初始可电击节律（OR 11.5，95%CI 7.6-17.3）与出院时的存活率呈正相关，而年龄（OR 0.97 岁，95%CI 0.96-0.98）、反应时间延长（OR 0.93 分钟，95%CI 0.89-0.97）、在家中发生（OR 0.4，95%CI 0.3-0.6）和肾上腺素剂量大于 3mg（OR 0.05，95%CI 0.03-0.08）与存活率呈负相关。
尽管是在治疗性低温和早期冠状动脉造影时代进行的，但复苏后的 SCD 患者的出院存活率仍然较差。目前的登记处提出了改善这些患者的院前和院内护理的方法。
