Yang Hyuk Jun, Kim Gi Woon, Kim Hyun, Cho Jin Seong, Rho Tai Ho, Yoon Han Deok, Lee Mi Jin
The ACLS Committee of the Korean Association of Cardiopulmonary Resuscitation, Seoul, Korea. ; Department of Emergency Medicine, Gachon University Gill Hospital, Incheon, Korea.
The ACLS Committee of the Korean Association of Cardiopulmonary Resuscitation, Seoul, Korea. ; Department of Emergency Medicine, School of Medicine, Ajou University, Suwon, Korea.
J Korean Med Sci. 2015 Jan;30(1):95-103. doi: 10.3346/jkms.2015.30.1.95. Epub 2014 Dec 23.
Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea.
心源性猝死（SCD）是影响国家卫生政策的一个重要问题。国家心脏骤停急诊科信息系统（NEDIS-CA）联盟在急诊科层面管理了一项院外心脏骤停（OHCA）的前瞻性登记。我们分析了2008年1月至2009年7月期间来自29家参与医院的NEDIS-CA数据。主要结局是OHCA的发生率和出院时的最终生存结局。将影响生存结局的因素作为次要结局进行评估。还调查了高级急救管理（药物、气管插管）和心脏骤停后护理（治疗性低温、冠状动脉介入）的实施情况。共纳入4156例尝试复苏的OHCA患者，其中401例（9.6%）患者存活至出院，79例（1.9%）出院时神经功能良好。在研究期间，参与医院的急诊科就诊人次为1662470次；因此，估计每400次急诊科就诊中有1例尝试复苏的心脏骤停（0.25%）。改善生存结局的因素包括年龄较小、有目击者目睹晕倒、在公共场所发病、院前可电击心律以及实施了高级复苏护理。我们发现积极的多学科高级复苏努力影响了生存率的提高。公众目击者进行的复苏改善了短期结局（自主循环恢复、存活入院），但未提高出院生存率。韩国需要采取策略来加强生存链和高质量心肺复苏。
