Uray Thomas, Sterz Fritz, Weiser Christoph, Schreiber Wolfgang, Spiel Alexander, Schober Andreas, Stratil Peter, Mayr Florian B
From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Medicine (Baltimore). 2015 Apr;94(14):e664. doi: 10.1097/MD.0000000000000664.
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.
既往研究表明，院外心脏骤停（OHCA）发生在夜间时预后较差。我们分析了非创伤性OHCA后被收入复苏中心的患者在白天和夜间是否接受了同等质量的心脏骤停后护理，以及护理质量是否会影响临床结局。我们分析了2006年1月至2013年5月间被维也纳总医院急诊科收治的心脏骤停后恢复自主循环患者的数据。报告的数据包括入院时间（根据人员配备情况，将白天定义为上午8点至下午4点）、开始低温治疗的时间以及ST段抬高型心肌梗死患者的门球时间。评估了患者12个月时的生存率和认知表现。在这项回顾性观察研究中，分析了1059例患者（74%为男性，n = 784），平均年龄为58±16岁。绝大多数患者在入院1小时内接受了诱导低温治疗（白天入院患者中77%，夜间入院患者中79%，P = 0.32）（白天入院患者从入院到降温的中位时间为27分钟（置信区间[CI]：10 - 60），夜间入院患者为23分钟（CI：11 - 59），P = 0.99）。在298例ST段抬高型心肌梗死患者中，白天和夜间入院患者的门球中位时间无差异（白天为82分钟，CI：60至142；夜间为86分钟，CI：50至135，P = 0.36）。在12个月时，490例白天入院患者中有238例存活，569例夜间入院患者中有275例存活（49%对48%，P = 0.94%），490例白天入院患者中有210例神经功能预后良好，569例夜间入院患者中有231例神经功能预后良好（43%对41%，P = 0.46）。OHCA后被收入我科的患者，无论白天还是夜间，接受及时高质量复苏后护理的可能性相同。白天和夜间入院患者12个月时的生存率和良好神经功能预后无差异。我们的结果可能支持设立专门的心脏骤停后护理中心这一理念。
