院外心脏骤停后再次骤停的发生率及结局
Incidence and outcomes of rearrest following out-of-hospital cardiac arrest.
作者信息
Salcido David D, Sundermann Matthew L, Koller Allison C, Menegazzi James J
机构信息
University of Pittsburgh School of Medicine, Department of Emergency Medicine, United States.
University of Pittsburgh School of Medicine, Department of Emergency Medicine, United States.
出版信息
Resuscitation. 2015 Jan;86:19-24. doi: 10.1016/j.resuscitation.2014.10.011. Epub 2014 Oct 23.
INTRODUCTION
Rearrest occurs when a patient experiences cardiac arrest after successful resuscitation. The incidence and outcomes of rearrest following out-of-hospital cardiac arrest have been estimated in limited local studies. We sought provide a large-scale estimate of rearrest incidence and its effect on survival.
METHODS
We obtained case data from emergency medical services-treated, out-of-hospital cardiac arrest from the Resuscitation Outcomes Consortium, a multi-site clinical research network with clinical centers in 11 regions in the US and Canada. The cohort comprised all cases captured between 2006 and 2008 at 10 of 11 regions with prehospital return of spontaneous circulation. We used three methods to ascertain rearrest via direct signal analysis, indirect signal analysis, and emergency department arrival vital status. Rearrest incidence was estimated as the proportion of cases with return of spontaneous circulation that experience rearrest. Regional rearrest incidence estimates were compared with the χ(2)-squared test. Multivariable logistic regression was used to assess the relationship between rearrest and survival to hospital discharge.
RESULTS
Out of 18,937 emergency medical services-assessed cases captured between 2006 and 2008, 11,456 (60.5%) cases were treated by emergency medical services and 4396 (38.4%) had prehospital return of spontaneous circulation. Of these, rearrest ascertainment data was available in 3253 cases, with 568 (17.5%) experiencing rearrest. Rearrest differed by region (10.2% to 21.2%, p < 0.001). Rearrest was inversely associated with survival (OR: 0.19, 95% CI: 0.14-0.26).
CONCLUSIONS
Rearrest was found to occur frequently after resuscitation and was inversely related to survival.
引言
复苏成功后的患者再次发生心脏骤停称为复发性心脏骤停。在有限的局部研究中，已经对院外心脏骤停后复发性心脏骤停的发生率和预后进行了评估。我们试图对复发性心脏骤停的发生率及其对生存率的影响进行大规模评估。
方法
我们从复苏结局联盟获取了经紧急医疗服务治疗的院外心脏骤停病例数据，该联盟是一个多中心临床研究网络，在美国和加拿大的11个地区设有临床中心。该队列包括2006年至2008年期间在11个地区中的10个地区发生的所有院外心脏骤停病例，这些病例在院前恢复了自主循环。我们使用三种方法通过直接信号分析、间接信号分析和急诊科到达时的生命体征来确定复发性心脏骤停。复发性心脏骤停的发生率估计为恢复自主循环后发生复发性心脏骤停的病例比例。使用卡方检验比较各地区复发性心脏骤停发生率的估计值。多变量逻辑回归用于评估复发性心脏骤停与出院生存率之间的关系。
结果
在2006年至2008年期间评估的18937例紧急医疗服务病例中，11456例（60.5%）接受了紧急医疗服务治疗，4396例（38.4%）在院前恢复了自主循环。其中，3253例病例有复发性心脏骤停的确切数据，568例（17.5%）发生了复发性心脏骤停。复发性心脏骤停在不同地区有所不同（10.2%至21.2%，p<0.001）。复发性心脏骤停与生存率呈负相关（OR：0.19，95%CI：0.14-0.26）。
结论
发现复发性心脏骤停在复苏后经常发生，并且与生存率呈负相关。
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