Kitamura Tetsuhisa, Morita Sachiko, Kiyohara Kosuke, Nishiyama Chika, Kajino Kentaro, Sakai Tomohiko, Nishiuchi Tatsuya, Hayashi Yasuyuki, Shimazu Takeshi, Iwami Taku
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Ymamada-oka, Suita 565-0871, Osaka, Japan.
Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita 565-0862, Osaka, Japan.
Resuscitation. 2014 Nov;85(11):1432-8. doi: 10.1016/j.resuscitation.2014.07.017. Epub 2014 Aug 7.
Little is known about the improvement in out-of-hospital cardiac arrest (OHCA) survival among elderly patients. The aim of this study was to evaluate the trends in the survival after bystander-witnessed OHCA of cardiac origin in this age group.
This prospective, population-based, observation of the whole population of Osaka, Japan included consecutive OHCA patients aged ≥65 years with emergency responder resuscitation attempts from January 1999 to December 2011. The primary outcome measure was one-month survival with neurologically favorable outcome, and the trends in the outcome from OHCA were evaluated by location. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome.
During the study period, a total of 10,876 bystander-witnessed OHCA of cardiac origin were eligible for our analyses. In whole arrests, the proportion of one-month survival with neurologically favorable outcome improved from 1.4% in 1999 to 4.8% in 2011 (P for trend <0.001). The proportion of neurologically favorable outcome in homes and public places improved from 0.7% in 1999 to 3.2% in 2011 (P for trend <0.001) and from 4.2% in 1999 to 20.9% in 2011 (P for trend <0.001), respectively, whereas, in nursing homes, the proportion of neurologically favorable outcome did not improve. In a multivariate analysis, bystander-initiated cardiopulmonary resuscitation and emergency response time were significant predictors for neurologically favorable outcome.
In this population, survival from OHCA among elderly patients significantly improved during the study period, but the trends differed by the OHCA location.
关于老年患者院外心脏骤停（OHCA）生存率的改善情况，人们了解甚少。本研究旨在评估该年龄组中心脏源性旁观者目击OHCA后的生存趋势。
这是一项基于日本大阪全体人口的前瞻性观察研究，纳入了1999年1月至2011年12月期间年龄≥65岁且有急救人员进行复苏尝试的连续OHCA患者。主要结局指标是1个月存活且神经功能良好，通过地点评估OHCA结局的趋势。采用多因素logistic回归分析评估与神经功能良好结局潜在相关的因素。
在研究期间，共有10876例心脏源性旁观者目击OHCA符合我们的分析条件。在所有心脏骤停病例中，1个月存活且神经功能良好的比例从1999年的1.4%提高到了2011年的4.8%（趋势P<0.001）。在家中和公共场所神经功能良好结局的比例分别从1999年的0.7%提高到了2011年的3.2%（趋势P<0.001）以及从1999年的4.2%提高到了2011年的20.9%（趋势P<0.001），而在养老院中，神经功能良好结局的比例没有改善。在多变量分析中，旁观者启动的心肺复苏和应急反应时间是神经功能良好结局的重要预测因素。
在该人群中，研究期间老年患者OHCA的生存率显著提高，但OHCA发生地点的趋势有所不同。
