Xiong Yan, Zhan Hong, Lu Yuanzheng, Guan Kaipan, Okoro Ngozi, Mitchell Denise, Dwyer Megan, Leatham Auna, Salazar Gilberto, Liao Xiaoxing, Idris Ahamed
Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Resuscitation. 2017 Mar;112:28-33. doi: 10.1016/j.resuscitation.2016.12.013. Epub 2016 Dec 21.
Return of spontaneous circulation (ROSC) in the field is a vital determinant contributing to survival from out-of-hospital cardiac arrest (OHCA). However, nearly one third of survivors at the Dallas-Fort Worth (DFW) Resuscitation Outcomes Consortium (ROC) site did not obtain ROSC in the field.
A retrospective, observational analysis was performed on all adult patients with non-traumatic OHCA treated on scene and transported to hospital, who did not gain ROSC in the field at DFW ROC site between 2006 through 2011.We described the demographics, pre-hospital characteristics and outcomes of all enrolled cases. Those patients without ROSC in the field, who did and did not meet Termination of Resuscitation (TOR) criteria in the field, were also compared.
Among a total of 5099 treated and transported non-traumatic OHCA cases, 83.2% (4243) were included in this study as patients without ROSC gained in the field, of which 66.6% (2827) met TOR criteria but still were treated and transported; 1.9% (79) survived to hospital discharge. Further analysis showed that 39.2% (31) of survivors met TOR rule, accounting for 1.1% of those patients who should have been declared dead in the field. Shockable initial rhythms, EMS-witnessed arrest, bystander CPR and age were factors significant to predict survival from OHCA without ROSC in the field. Of concern, 1.7% (47) of patients who met TOR presented initially shockable rhythms but no shocks were delivered in the field.
We suggest that all treated non-traumatic OHCA patients should be transported to hospital.
现场恢复自主循环（ROSC）是院外心脏骤停（OHCA）患者生存的关键决定因素。然而，达拉斯-沃思堡（DFW）复苏结局联盟（ROC）站点近三分之一的幸存者在现场未实现ROSC。
对2006年至2011年间在DFW ROC站点现场接受治疗并转运至医院的所有非创伤性OHCA成年患者进行回顾性观察分析。我们描述了所有纳入病例的人口统计学特征、院前特征和结局。还比较了现场未实现ROSC且符合和不符合复苏终止（TOR）标准的患者。
在总共5099例接受治疗并转运的非创伤性OHCA病例中，83.2%（4243例）被纳入本研究，这些患者在现场未实现ROSC，其中66.6%（2827例）符合TOR标准但仍接受了治疗和转运；1.9%（79例）存活至出院。进一步分析显示，39.2%（31例）的幸存者符合TOR规则，占现场本应宣布死亡患者的1.1%。可电击的初始心律、急救医疗服务（EMS）见证的心脏骤停、旁观者心肺复苏（CPR）和年龄是预测现场未实现ROSC的OHCA患者生存的重要因素。值得关注的是，1.7%（47例）符合TOR标准的患者最初表现为可电击心律，但现场未进行电击。
我们建议所有接受治疗的非创伤性OHCA患者均应转运至医院。
