Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States; Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States; David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States.
Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States; David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States.
Resuscitation. 2014 Jul;85(7):915-9. doi: 10.1016/j.resuscitation.2014.04.001. Epub 2014 Apr 13.
Dismal prognosis after failed out-of-hospital resuscitation has previously been demonstrated. Changes in resuscitation and post-resuscitation care may affect patient outcomes. We describe characteristics and outcomes of patients with out-of-hospital cardiac arrest (OOHCA) transported to specialty cardiac centers after failure of out-of-hospital interventions.
In Los Angeles (LA) County, patients with non-traumatic OOHCA with return of spontaneous circulation (ROSC) are transported to specialized cardiac care centers. Outcomes are reported to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report patient characteristics and outcomes for the subset of patients treated at these specialty centers in whom initial ROSC was achieved in the ED. The primary outcome was neurologically intact survival, defined by a cerebral performance category (CPC) score of 1 or 2.
105 patients transported to the SRC after failure to achieve ROSC with out-of-hospital resuscitation were successfully resuscitated in the ED. The median age was 68 years (IQR 57-78); 74 (70%) were male. The presenting rhythm was ventricular fibrillation or ventricular tachycardia in 40 patients (38%) and 86 (82%) were witnessed. Twenty-two patients (21%) survived to hospital discharge. Of the 103 patients with known CPC scores, 13 (13% [95% CI 7-21%]) survived to hospital discharge with a CPC score of 1 or 2. No patient who survived with good neurologic outcome met criteria for termination of resuscitation in the field.
Failure of out-of-hospital resuscitation is not universally predictive of poor neurologic outcome.
先前已经证明，院外复苏失败后的预后不佳。复苏和复苏后护理的变化可能会影响患者的结局。我们描述了在院外干预失败后被转运至专科心脏中心的院外心脏骤停（OHCA）患者的特征和结局。
在洛杉矶（LA）县，有自主循环恢复（ROSC）的非创伤性 OHCA 患者被转运至专门的心脏护理中心。结局报告给由 LA 县紧急医疗服务（EMS）机构维护的登记处。我们报告了在这些专科中心接受治疗的患者子集的患者特征和结局，这些患者在 ED 中初始 ROSC 得以实现。主要结局是神经功能完整的存活，定义为脑功能表现类别（CPC）评分 1 或 2。
105 名在院外复苏未能实现 ROSC 后被转运至 SRC 的患者在 ED 成功复苏。中位数年龄为 68 岁（IQR 57-78）；74 名（70%）为男性。起始节律为室颤或室性心动过速的有 40 名患者（38%），86 名患者（82%）有目击者。22 名患者（21%）存活至出院。在已知 CPC 评分的 103 名患者中，13 名（13% [95%CI 7-21%]）存活至出院时 CPC 评分为 1 或 2。没有存活且神经功能良好的患者符合现场终止复苏的标准。
院外复苏失败并不普遍预示着不良的神经结局。
