Matsuyama Tasuku, Kiyohara Kosuke, Kitamura Tetsuhisa, Nishiyama Chika, Nishiuchi Tatsuya, Hayashi Yasuyuki, Kawamura Takashi, Ohta Bon, Iwami Taku
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
Resuscitation. 2017 Jan;110:146-153. doi: 10.1016/j.resuscitation.2016.11.009. Epub 2016 Nov 25.
To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA).
This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012. We divided acute care hospitals into CCMCs or non-CCMCs, the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases: low-volume (≤10 cases), middle-volume (11-39 cases), and high-volume (≥40 cases) groups. Random effects logistic regression models, with hospital treated as a random effect, were used to assess factors potentially associated with a favourable neurological outcome.
A total of 44,474 patients were eligible. The proportions of favourable neurological outcome from OHCA were 0.9% (31/3559) in the low-volume group, 1.2% (106/9171) in the middle-volume group, 1.6% (222/14,007) in the high-volume group, and 4.3% (766/17,737) in the CCMC group (P<0.001). In the multivariable analysis, transport to CCMCs was significantly associated with favourable neurological outcome, compared with transport to non-CCMCs (adjusted odds ratio 1.63; 95% confidence interval, 1.60-1.66). Among the non-CCMC group, there was no significant relationship between hospital volume and favourable neurological outcome.
In this population, transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA, whereas no significant association was noted among the hospitals with different volumes.
评估院外心脏骤停（OHCA）后良好神经功能预后与医院特征（如医院规模和重症监护中心数量）之间的关联。
这项在日本大阪府进行的基于人群的回顾性观察研究纳入了2005年1月至2012年12月期间被转运至急症医院的年龄≥18岁的成年OHCA患者。我们将急症医院分为重症监护中心（CCMC）或非CCMC，后者根据每年转运的OHCA病例平均数量分为以下三组：低容量组（≤10例）、中容量组（11 - 39例）和高容量组（≥40例）。采用以医院为随机效应的随机效应逻辑回归模型来评估与良好神经功能预后潜在相关的因素。
共有44474例患者符合条件。OHCA后良好神经功能预后的比例在低容量组为0.9%（31/3559），中容量组为1.2%（106/9171），高容量组为1.6%（222/14007），CCMC组为4.3%（766/17737）（P<0.001）。在多变量分析中，与转运至非CCMC相比，转运至CCMC与良好神经功能预后显著相关（调整后的优势比为1.63；95%置信区间为1.60 - 1.66）。在非CCMC组中，医院规模与良好神经功能预后之间无显著关系。
在该人群中，将OHCA患者转运至CCMC可显著提高OHCA后具有良好神经功能预后的1个月生存率，而不同规模医院之间未发现显著关联。
