Andrew E, Nehme Z, Lijovic M, Bernard S, Smith K
Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia.
Department of Research and Evaluation, Ambulance Victoria, Doncaster, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, VIC, Australia.
Resuscitation. 2014 Nov;85(11):1633-9. doi: 10.1016/j.resuscitation.2014.07.015. Epub 2014 Aug 7.
While internationally reported survival from out-of-hospital cardiac arrest (OHCA) is improving, much of the increase is being observed in patients presenting to emergency medical services (EMS) in shockable rhythms. The purpose of this study was to assess survival and 12-month functional recovery in patients presenting to EMS in asystole or pulseless electrical activity (PEA).
The Victorian Ambulance Cardiac Arrest Registry was searched for adult OHCA patients presenting in non-shockable rhythms in Victoria, Australia between 1st July 2003 and 30th June 2013. We excluded patients defibrillated prior to EMS arrival and arrests witnessed by EMS. Twelve-month quality-of-life interviews were conducted on survivors who arrested between 1st January 2010 and 31st December 2012. The main outcome measures were survival to hospital discharge and 12-month functional recovery measured by the Extended Glasgow Outcome Scale (GOSE).
A total of 38,378 non-shockable OHCA attended by EMS were included, of which 88.0% were asystole and 11.6% were PEA. Of the patients receiving resuscitation, survival to hospital discharge was 1.1% for asystole and 5.9% for PEA (p<0.001), with no significant improvement observed over the 10 year study period. In survivors with 12-month follow-up data, the combined rate of death, vegetative state or lower severe disability was 66.7% (95% CI 41.0-80.0%) for asystole and 44.7% (95% CI 30.2-59.9%) for PEA.
Survival outcomes following OHCA with initial rhythms of asystole or PEA did not improve over the 10-year study period. Our findings indicate high rates of death within 12 months, and unfavourable functional recovery for survivors.
虽然国际上报告的院外心脏骤停（OHCA）生存率正在提高，但大部分增长见于以可电击心律就诊于紧急医疗服务（EMS）的患者。本研究的目的是评估以心脏停搏或无脉电活动（PEA）就诊于EMS的患者的生存率和12个月功能恢复情况。
检索维多利亚州救护车心脏骤停登记处，查找2003年7月1日至2013年6月30日期间在澳大利亚维多利亚州以不可电击心律就诊的成年OHCA患者。我们排除了在EMS到达之前接受除颤的患者以及由EMS目击的心脏骤停患者。对2010年1月1日至2012年12月31日期间发生心脏骤停的幸存者进行了为期12个月的生活质量访谈。主要结局指标为出院生存率以及通过扩展格拉斯哥结局量表（GOSE）测量的12个月功能恢复情况。
共纳入38378例由EMS处理的不可电击OHCA患者，其中88.0%为心脏停搏，11.6%为PEA。在接受复苏的患者中，心脏停搏患者的出院生存率为1.1%，PEA患者为5.9%（p<0.001），在10年研究期间未观察到显著改善。在有12个月随访数据的幸存者中，心脏停搏患者的死亡、植物状态或较低严重残疾合并发生率为66.7%（95%CI 41.0 - 80.0%），PEA患者为44.7%（95%CI 30.2 - 59.9%）。
在10年研究期间，初始心律为心脏停搏或PEA的OHCA患者的生存结局未得到改善。我们的研究结果表明12个月内死亡率高，且幸存者功能恢复不佳。
