Whittaker Andrew, Lehal Manpreet, Calver Alison L, Corbett Simon, Deakin Charles D, Gray Huon, Simpson Iain, Wilkinson James R, Curzen Nicholas
Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Faculty of Medicine, University of Southampton, Southampton, UK.
Postgrad Med J. 2016 May;92(1087):250-4. doi: 10.1136/postgradmedj-2015-133575. Epub 2016 Jan 6.
Out-of-hospital cardiac arrest (OHCA) has a poor prognosis despite bystander resuscitation and rapid transfer to hospital. Optimal management of patients after arrival to hospital continues to be contentious, especially the timing of emergency coronary angiography±revascularisation. Robust predictors of inhospital outcome would be of clinical value for initial decision-making.
A retrospective analysis of consecutive patients who presented to a university hospital following OHCA over a 70-month period (2008-2013). Patients were identified from the emergency department electronic patient registration and coding system. For those patients who underwent emergency percutaneous coronary intervention, details were crosschecked with national databases.
We identified 350 consecutive patients who were brought to our hospital following OHCA. Return of spontaneous circulation (ROSC) for >20 min was achieved either before arrival or inhospital in 196 individuals. From the 350 subjects, 114 (32.6%) survived to hospital discharge. When sustained ROSC was achieved, either before or inhospital, survival to discharge was 58.2% (114 of 196). Non-shockable rhythm, absence of bystander cardiopulmonary resuscitation, 'downtime' >15 min and initial pH ≤7.11 were predictors of inhospital death. 12% patients who underwent angiography in the presence of ST elevation had no acute coronary occlusion. 21% patients with acute coronary occlusion at angiography did not have ST elevation.
In our cohort of patients with OHCA, those who achieve ROSC had a survival-to-discharge rate of 58.2%. We identified four predictors of inhospital death, which are readily available at the time of patient presentation. Reliance on ST elevation to decide about coronary angiography and revascularisation may be flawed. More data are required.
尽管有旁观者进行复苏并迅速转运至医院，但院外心脏骤停（OHCA）的预后仍然很差。患者入院后的最佳管理方案仍存在争议，尤其是急诊冠状动脉造影及血运重建的时机。可靠的院内结局预测指标对于初始决策具有临床价值。
对一所大学医院在70个月期间（2008 - 2013年）因OHCA就诊的连续患者进行回顾性分析。通过急诊科电子患者登记和编码系统识别患者。对于接受急诊经皮冠状动脉介入治疗的患者，其详细信息与国家数据库进行交叉核对。
我们确定了350例因OHCA被送至我院的连续患者。196例患者在到达医院之前或入院后实现自主循环恢复（ROSC）超过20分钟。在这350名受试者中，114例（32.6%）存活至出院。当在到达医院之前或入院后实现持续性ROSC时，出院存活率为58.2%（196例中的114例）。不可电击心律、无旁观者心肺复苏、“停搏时间”>15分钟以及初始pH≤7.11是院内死亡的预测指标。12%在ST段抬高情况下接受血管造影的患者没有急性冠状动脉闭塞。21%血管造影时有急性冠状动脉闭塞的患者没有ST段抬高。
在我们的OHCA患者队列中，实现ROSC的患者出院存活率为58.2%。我们确定了四个院内死亡预测指标，这些指标在患者就诊时即可获得。依靠ST段抬高来决定冠状动脉造影和血运重建可能存在缺陷。还需要更多数据。
