Masterson Siobhán, Cullinan John, McNally Bryan, Deasy Conor, Murphy Andrew, Wright Peter, O'Reilly Martin, Vellinga Akke
Discipline of General Practice, National University of Ireland Galway, Galway, Ireland.
School of Business and Economics, National University of Ireland Galway, Galway, Ireland.
Emerg Med J. 2016 Nov;33(11):776-781. doi: 10.1136/emermed-2015-205107. Epub 2016 Aug 2.
National data collection provides information on out-of-hospital cardiac arrest (OHCA) incidence, management and outcomes that may not be generalisable from smaller studies. This retrospective cohort study describes the first 2 years' results from the Irish National Out-of-Hospital Cardiac Arrest Register (OHCAR).
Data on OHCAs attended by emergency medical services (EMS) where resuscitation was attempted (EMS-treated) were collected from ambulance services and entered onto OHCAR. Descriptive analysis of the study population was performed, and regression analysis was performed on the subgroup of adult patients with a bystander-witnessed event of presumed cardiac aetiology and an initial shockable rhythm (Utstein group).
3701 EMS-treated OHCAs were recorded for the study period (1 January 2012-31 December 2013). Incidence was 39/100 000 population/year. In the Utstein group (n=577), compared with the overall group, there was a higher proportion of male patients, public event location, bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Median EMS call-response interval was similar in both groups. A higher proportion of patients in the Utstein group achieved return of spontaneous circulation (35% vs 17%) and survival to hospital discharge (22% vs 6%). After multivariate adjustment for the Utstein group, the following variables were found to be independent predictors of the outcome survival to hospital discharge: public event location (OR 3.1 (95% CI 1.9 to 5.0)); bystander CPR (2.4 (95% CI 1.2 to 4.9)); EMS response of 8 min or less (2.2 (95% CI 1.3 to 3.6)).
This study highlights the role of nationwide registries in quantifying, monitoring and benchmarking OHCA incidence and outcome, providing baseline data upon which service improvement effects can be measured.
国家数据收集提供了院外心脏骤停（OHCA）发病率、管理及预后方面的信息，这些信息可能无法从小规模研究中推广得出。这项回顾性队列研究描述了爱尔兰国家院外心脏骤停登记处（OHCAR）前两年的结果。
从急救服务机构收集尝试进行复苏的院外心脏骤停（由急救医疗服务机构[EMS]处理）的数据，并录入OHCAR。对研究人群进行描述性分析，并对有旁观者目睹、推测为心脏病因且初始心律可电击复律的成年患者亚组（Utstein组）进行回归分析。
在研究期间（2012年1月1日至2013年12月31日）记录了3701例由EMS处理的院外心脏骤停病例。发病率为每年39/10万人口。在Utstein组（n = 577）中，与总体组相比，男性患者、公共场所事件发生地点、旁观者心肺复苏（CPR）和早期除颤的比例更高。两组的EMS呼叫响应中位间隔相似。Utstein组中有更高比例的患者实现了自主循环恢复（35%对17%）和存活至出院（22%对6%）。对Utstein组进行多变量调整后，发现以下变量是存活至出院这一预后的独立预测因素：公共场所事件发生地点（比值比[OR] 3.1[95%置信区间（CI）1.9至5.0]）；旁观者CPR（2.4[95% CI 1.2至4.9]）；EMS响应时间为8分钟或更短（2.2[95% CI 1.3至3.6]）。
本研究强调了全国登记处对于量化、监测和规范院外心脏骤停发病率及预后的作用，提供了可用于衡量服务改善效果的基线数据。
