Holmén Johan, Hollenberg Jacob, Claesson Andreas, Herrera Maria Jiménez, Azeli Youcef, Herlitz Johan, Axelsson Christer
Dept. of Prehospital and Emergency Care, Dept. of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Dept. of Pediatric Anesthesia and Intensive Care, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden Institute of Medicine, Sahlgrenska University Hospital, Sweden.
Center for Resuscitation Science, Dept. for Medicine, Karolinska Institutet, Stockholm, Sweden.
Resuscitation. 2017 Apr;113:33-38. doi: 10.1016/j.resuscitation.2017.01.006. Epub 2017 Jan 18.
Mortality after out of hospital cardiac arrest (OHCA) is high and a shockable rhythm is a key predictor of survival. A concomitant need for repeated shocks appears to be associated with less favorable outcome.
To, among patients found in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) describe: (a) factors associated with 30-day survival with emphasis on the number of defibrillatory shocks delivered; (b) the distribution of and the characteristics of patients in relation to the number of defibrillatory shocks that were delivered.
Patients who were reported to The Swedish Register for Cardiopulmonary Resuscitation (SRCR) between January 1 1990 and December 31 2015 and who were found in VF/pVT took part in the survey.
In all there were 19,519 patients found in VF/pVT. The 30-day survival decreased with an increasing number of shocks among all patients regardless of witnessed status and regardless of time period in the survey. In a multivariate analysis there were 12 factors that were associated with the chance of 30-day survival one of which was the number of shocks that was delivered. For each shock that was added the chance of survival decreased. Factors associated with an increased 30-day survival included CPR before arrival of EMS, female sex, cardiac etiology and year of OHCA (increasing survival over years). Factors associated with a decreased chance of 30-day survival included: increasing age, OHCA at home, the use of adrenaline and intubation and an increased delay to CPR, defibrillation and EMS arrival.
Among patients found in VF/pVT, 7.5% required more than 10 shocks. For each shock that was added the chance of 30-day survival decreased. There was an increase in 30-day survival over time regardless of the number of shocks. On top of the number of defibrillations, eleven further factors were associated with 30-day survival.
院外心脏骤停（OHCA）后的死亡率很高，可电击心律是生存的关键预测因素。需要多次电击似乎与较差的预后相关。
在心室颤动（VF）或无脉性室性心动过速（pVT）患者中描述：（a）与30天生存率相关的因素，重点是除颤电击次数；（b）根据除颤电击次数划分的患者分布及特征。
1990年1月1日至2015年12月31日期间报告至瑞典心肺复苏登记处（SRCR）且被发现为VF/pVT的患者参与了该调查。
共有19519例患者被发现为VF/pVT。在所有患者中，无论是否被目击以及调查中的时间段如何，30天生存率均随电击次数增加而降低。多因素分析中有12个因素与30天生存机会相关，其中之一是电击次数。每增加一次电击，生存机会就会降低。与30天生存率增加相关的因素包括急救医疗服务（EMS）到达前的心肺复苏（CPR）、女性、心脏病因以及OHCA发生年份（逐年生存率增加）。与30天生存机会降低相关的因素包括：年龄增加、在家中发生OHCA、使用肾上腺素和插管以及CPR、除颤和EMS到达的延迟增加。
在被发现为VF/pVT的患者中，7.5%需要超过10次电击。每增加一次电击，30天生存机会就会降低。无论电击次数如何，30天生存率随时间推移有所增加。除了除颤次数外，还有另外11个因素与30天生存率相关。
