Karlsson Lena I M, Wissenberg Mads, Fosbøl Emil L, Hansen Carolina Malta, Lippert Freddy K, Bagai Akshay, McNally Bryan, Granger Christopher B, Christensen Erika Frischknecht, Folke Fredrik, Rajan Shahzleen, Weeke Peter, Nielsen Søren L, Køber Lars, Gislason Gunnar H, Torp-Pedersen Christian
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
Resuscitation. 2014 Sep;85(9):1161-8. doi: 10.1016/j.resuscitation.2014.06.012. Epub 2014 Jun 24.
To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA).
OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59.
We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively).
We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.
调查院外心脏骤停（OHCA）后发病率和预后的昼夜变化。
通过丹麦全国心脏骤停登记处（2001 - 2010年）确定推测为心脏病因的OHCA。一天的时间分为三个时间段：白天07:00 - 14:59；晚上15:00 - 22:59；夜间23:00 - 06:59。
我们确定了18929例年龄≥18岁的OHCA患者。中位年龄为72岁（四分位间距62 - 80），大多数为男性（67.5%）。OHCA的发生在不同时间段有所不同，分别有43.9%、35.7%和20.6%发生在白天、晚上和夜间。夜间患者更有可能出现以下情况：严重合并症（如慢性阻塞性肺疾病）、在私人住宅中发生心脏骤停（分别为87.2%，而白天和晚上分别为69.0%和73.0%）、未被目击的心脏骤停（51.2%，而白天和晚上分别为48.4%和43.7%）、没有旁观者进行心肺复苏（75.9%，而白天和晚上分别为68.4%和66.1%）、从识别OHCA到进行节律分析的时间间隔更长（12分钟，而白天和晚上分别为11分钟和11分钟）以及不可电击心律（80.1%，而白天和晚上分别为70.3%和69.4%），所有p<0.0001。夜间患者到达医院时实现自主循环恢复的可能性较小（7.5%，而白天和晚上分别为14.8%和15.1%）以及1年生存率较低（2.8%，而白天和晚上分别为7.2%和7.1%），p<0.0001。总体而言，在对上述患者相关和心脏骤停相关特征进行调整后，1年生存率较低的情况仍然存在（与白天和晚上相比，调整后的比值比分别为0.47，95%置信区间0.37 - 0.59；0.51，95%置信区间0.40 - 0.65）。
我们发现夜间患者的生存率低于白天和晚上，在对包括合并症在内的患者相关和心脏骤停相关特征进行调整后，这种情况仍然存在。
