Schober Andreas, Sterz Fritz, Laggner Anton N, Poppe Michael, Sulzgruber Patrick, Lobmeyr Elisabeth, Datler Philip, Keferböck Markus, Zeiner Sebastian, Nuernberger Alexander, Eder Bettina, Hinterholzer Georg, Mydza Daniel, Enzelsberger Barbara, Herbich Klaus, Schuster Reinhard, Koeller Elke, Publig Thomas, Smetana Peter, Scheibenpflug Chrisitian, Christ Günter, Meyer Brigitte, Uray Thomas
Department of Emergency Medicine, Medical University of Vienna, Austria.
Department of Emergency Medicine, Medical University of Vienna, Austria.
Resuscitation. 2016 Sep;106:42-8. doi: 10.1016/j.resuscitation.2016.06.021. Epub 2016 Jun 28.
Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to high-, medium- or low volume centers.
Analysis from a prospective, multicenter registry for out of hospital cardiac arrest patients treated by the emergency medical service of Vienna, Austria. The frequency of cardiac arrest patients admitted per center/year (low <50; medium 50-100; high >100) was correlated to favorable outcome (30-day survival with cerebral performance category of 1 or 2).
Out of 2238 patients (years 2013-2015) with emergency medical service resuscitation, 861 (32% female, age 64 (51;73) years) were admitted to 7 different centers. Favorable outcome was achieved in 267 patients (31%). Survivors were younger (58 vs. 66 years; p<0.001), showed shockable initial heart rhythm more frequently (72 vs. 35%; p<0.001), had shorter CPR durations (22 vs. 29min; p<0.001) and were more likely to be treated in a high frequency center (OR 1.6; CI: 1.2-2.1; p=0.001). In multivariate analysis, age below 65 years (OR 15; CI: 3.3-271.4; p=0.001), shockable initial heart rhythm (OR 10.1; CI: 2.4-42.6; p=0.002), immediate bystander or emergency medical service CPR (OR 11.2; CI: 1.4-93.3; p=0.025) and admission to a center with a frequency of >100 OHCA patients/year (OR 5.2; CI: 1.2-21.7; p=0.025) was associated with favorable outcome.
High frequency of post-cardiac arrest treatment in a specialized center seems to be an independent predictor for favorable outcome in an unselected population of patients after out of hospital cardiac arrest.
心脏骤停中心与心脏骤停患者预后改善相关。本研究旨在探讨患者入住高、中、低容量中心对预后的影响。
对奥地利维也纳紧急医疗服务部门治疗的院外心脏骤停患者的前瞻性多中心登记数据进行分析。将每个中心每年收治的心脏骤停患者频率（低<50例；中50 - 100例；高>100例）与良好预后（30天存活且脑功能分类为1或2）进行关联分析。
在2238例（2013 - 2015年）接受紧急医疗服务复苏的患者中，861例（女性占32%，年龄64（51；73）岁）被收治到7个不同中心。267例（31%）患者获得良好预后。存活者更年轻（58岁对66岁；p<0.001），初始可电击心律出现频率更高（72%对35%；p<0.001），心肺复苏持续时间更短（22分钟对29分钟；p<0.001），且更有可能在高频率中心接受治疗（比值比1.6；可信区间：1.2 - 2.1；p = 0.001）。多因素分析显示，年龄低于65岁（比值比15；可信区间：3.3 - 271.4；p = 0.001）、初始可电击心律（比值比10.1；可信区间：2.4 - 42.6；p = 0.002）、旁观者或紧急医疗服务立即进行心肺复苏（比值比11.2；可信区间：1.4 - 93.3；p = 0.025）以及入住每年心脏骤停患者频率>100例的中心（比值比5.2；可信区间：1.2 - 21.7；p = 0.025）与良好预后相关。
在专门中心进行高频率的心脏骤停后治疗似乎是院外心脏骤停患者未选择人群良好预后的独立预测因素。
