Kitamura Nobuya, Nakada Taka-Aki, Shinozaki Koichiro, Tahara Yoshio, Sakurai Atsushi, Yonemoto Naohiro, Nagao Ken, Yaguchi Arino, Morimura Naoto
Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-City, Chiba, 292-8535, Japan.
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba, 260-8677, Japan.
Crit Care. 2015 Sep 10;19(1):322. doi: 10.1186/s13054-015-1028-0.
Previous studies evaluating whether subsequent conversion to shockable rhythms in patients who had initially non-shockable rhythms was associated with altered clinical outcome reported inconsistent results. Therefore, we hypothesized that subsequent shock delivery by emergency medical service (EMS) providers altered clinical outcomes in patients with initially non-shockable rhythms.
We tested for an association between subsequent shock delivery in EMS resuscitation and clinical outcomes in patients with initially non-shockable rhythms (n = 11,481) through a survey of patients after out-of-hospital cardiac arrest in the Kanto region (SOS-KANTO) 2012 study cohort, Japan. The primary investigated outcome was 1-month survival with favorable neurological functions. The secondary outcome variable was the presence of subsequent shock delivery. We further evaluated the association of interval from initiation of cardiopulmonary resuscitation to shock with clinical outcomes.
In the univariate analysis of initially non-shockable rhythms, patients who received subsequent shock delivery had significantly increased frequency of return of spontaneous circulation, 24-hour survival, 1-month survival, and favorable neurological outcomes compared to the subsequent not shocked group (P < 0.0001). In the multivariate logistic regression analysis, subsequent shock was significantly associated with favorable neurological outcomes (vs. not shocked; adjusted P = 0.0020, odds ratio, 2.78; 95% confidence interval, 1.45-5.30). Younger age, witnessed arrest, initial pulseless electrical activity rhythms, and cardiac etiology were significantly associated with the presence of subsequent shock in patients with initially non-shockable rhythms.
In this study of cardiac arrest patients with initially non-shockable rhythms, patients who received early defibrillation by EMS providers had increased 1-month favorable neurological outcomes.
先前的研究评估了最初为非可电击心律的患者随后转为可电击心律是否与临床结局改变相关，结果并不一致。因此，我们推测紧急医疗服务（EMS）人员随后进行的电击会改变最初为非可电击心律患者的临床结局。
我们通过对日本关东地区院外心脏骤停患者的调查（SOS-KANTO 2012研究队列），测试了EMS复苏中随后的电击与最初为非可电击心律患者（n = 11,481）的临床结局之间的关联。主要研究结局是1个月存活且神经功能良好。次要结局变量是是否有随后的电击。我们进一步评估了从心肺复苏开始到电击的间隔与临床结局的关联。
在对最初为非可电击心律的单因素分析中，与随后未接受电击的组相比，接受随后电击的患者自主循环恢复、24小时存活、1个月存活以及良好神经功能结局的频率显著增加（P < 0.0001）。在多因素逻辑回归分析中，随后的电击与良好的神经功能结局显著相关（与未电击相比；校正P = 0.0020，比值比为2.78；95%置信区间为1.45 - 5.30）。年龄较小、有目击者的心脏骤停、最初的无脉电活动心律以及心脏病因与最初为非可电击心律患者随后接受电击显著相关。
在这项针对最初为非可电击心律的心脏骤停患者的研究中，接受EMS人员早期除颤的患者1个月时神经功能良好结局增加。
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