Department of Cardiology, the Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, the Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Ann Emerg Med. 2015 May;65(5):523-531.e2. doi: 10.1016/j.annemergmed.2014.12.009. Epub 2014 Dec 24.
Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region.
We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted resuscitation in Copenhagen. From an Utstein database, we assessed survival to admission and comorbidity with the Charlson comorbidity index from the National Patient Registry and employment status from the Danish Rational Economic Agents Model database. We used logistic regression analyses to identify factors associated with outcome.
Of a total of 2,527 attempted resuscitations in out-of-hospital cardiac arrest patients, 40% (n=1,015) were successfully resuscitated and admitted to the hospital. The strongest independent factors associated with successful resuscitation were shockable primary rhythm (multivariate odds ratio [OR]=3.9; 95% confidence interval [CI] 3.1 to 5.0), witnessed arrest (multivariate OR=3.5; 95% CI 2.7 to 4.6), and out-of-hospital cardiac arrest in a public area (multivariate OR=2.1; 95% CI 1.6 to 2.8), whereas no comorbidity (multivariate OR=1.1; 95% CI 0.8 to 1.45), sex (multivariate OR=1.14; 95% CI 0.91 to 1.44), and employment status (multivariate OR=1.17; 95% CI 0.89 to 1.56) were not independently associated with outcome. The number of patients with a high comorbidity burden (Charlson comorbidity index ≥3) increased during the study period (P trend <.001), from 18% to 31% (P trend <.001), whereas the percentage of out-of-hospital cardiac arrest patients with successful resuscitation to hospital admission increased by 3% per year during the study period, from 37% in 2007 to 43% in 2011 (P trend <.001).
Our observations confirm the importance of key features that influence out-of-hospital cardiac arrest survival to hospital admission but are not highly influenced by public health actions. Despite increased illness burden, this short term outcome from cardiac arrest improved as care system efforts matured.
院外心脏骤停的整体预后较差。我们试图确定在一个地区存在哪些时间趋势和影响因素。
我们研究了 2007 年至 2011 年哥本哈根尝试复苏的连续院外心脏骤停患者。从 utstein 数据库中，我们评估了国家患者登记处的 Charlson 合并症指数和丹麦理性经济代理人模型数据库的就业状况与入院存活率相关的合并症。我们使用逻辑回归分析来确定与结果相关的因素。
在总共 2527 例院外心脏骤停患者的尝试复苏中，40%（n=1015）成功复苏并入院。与成功复苏最密切相关的独立因素是可除颤的原发性节律（多变量优势比[OR]=3.9；95%置信区间[CI]3.1 至 5.0）、目击者见证（多变量 OR=3.5；95%CI 2.7 至 4.6）和公共区域的院外心脏骤停（多变量 OR=2.1；95%CI 1.6 至 2.8），而无合并症（多变量 OR=1.1；95%CI 0.8 至 1.45）、性别（多变量 OR=1.14；95%CI 0.91 至 1.44）和就业状况（多变量 OR=1.17；95%CI 0.89 至 1.56）与结果无独立关系。在研究期间，患有高合并症负担（Charlson 合并症指数≥3）的患者数量增加（趋势 P<.001），从 18%增加到 31%（趋势 P<.001），而在研究期间，每年成功复苏至入院的院外心脏骤停患者比例增加 3%，从 2007 年的 37%增加到 2011 年的 43%（趋势 P<.001）。
我们的观察结果证实了影响院外心脏骤停入院存活率的关键特征的重要性，但这些特征受公共卫生措施的影响较小。尽管疾病负担增加，但随着医疗系统努力的成熟，心脏骤停的这一短期结果得到了改善。
