Parry Monica, Danielson Kyle, Brennenstuhl Sarah, Drennan Ian R, Morrison Laurie J
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Resuscitation. 2017 Apr;113:21-26. doi: 10.1016/j.resuscitation.2017.01.011. Epub 2017 Jan 23.
Sudden cardiac arrest (SCA), confirmed absence of cardiac mechanical activity, is the leading cause of heart-related death in the US. Almost 85% of SCA occur out-of-hospital (OHCA), with very poor rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. We sought to determine if diabetes status was associated with survival or ROSC following an OHCA.
We completed a retrospective cohort study using data from the Toronto Regional RescuNet Epistry dataset, based upon data definitions defined by the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest and the Strategies for Post Arrest Resuscitation Care (SPARC) network datasets. Adults ≥18years of age who experienced an OHCA, had data on diabetes status, and were treated by Emergency Medical Services (EMS) between 2012-2014 were included in the analysis (n=10,097). We used bivariate analyses to examine relationships between diabetes status, Utstein elements and outcomes, and logistic regression to determine predictors of survival.
Diabetes prevalence was 27.8% (95% CI: 27.0-28.7). A larger proportion of those with diabetes had a non-shockable initial rhythm (28.8% vs. 25.1%; p<0.01) and did not survive to hospital discharge (92.1% vs. 89.2%, p<0.001). Diabetes status is associated with a decrease in survival, independent from a number of Utstein elements (adjusted OR=0.76; 95% CI: 0.64-0.91, p=0.003).
This is the first Canadian study to examine the association between diabetes status and OHCA outcomes. Our findings suggest that diabetes status prior to arrest is associated with decreased survival. The growing prevalence of diabetes globally suggests a future burden related to OHCAs.
心脏骤停（SCA），即经确认心脏无机械活动，是美国心脏相关死亡的主要原因。几乎85%的心脏骤停发生在院外（OHCA），自主循环恢复（ROSC）率和存活至出院的比例极低。我们试图确定糖尿病状态是否与院外心脏骤停后的存活或自主循环恢复相关。
我们使用多伦多地区救援网络Epistry数据集的数据，完成了一项回顾性队列研究，该数据集基于复苏结果联盟（ROC）Epistry-心脏骤停和心脏骤停后复苏护理策略（SPARC）网络数据集所定义的数据定义。纳入分析的对象为2012年至2014年间经历院外心脏骤停、有糖尿病状态数据且接受过紧急医疗服务（EMS）治疗的18岁及以上成年人（n = 10,097）。我们采用双变量分析来检验糖尿病状态、Utstein要素与结局之间的关系，并使用逻辑回归来确定存活的预测因素。
糖尿病患病率为27.8%（95%置信区间：27.0 - 28.7）。糖尿病患者中，初始心律不可电击复律者的比例更高（28.8%对25.1%；p < 0.01），且未存活至出院的比例也更高（92.1%对89.2%，p < 0.001）。糖尿病状态与存活降低相关，独立于多个Utstein要素（调整后的比值比 = 0.76；95%置信区间：0.64 - 0.91，p = 0.003）。
这是加拿大第一项研究糖尿病状态与院外心脏骤停结局之间关联的研究。我们的研究结果表明，心脏骤停前的糖尿病状态与存活降低相关。全球糖尿病患病率的不断上升表明未来院外心脏骤停将带来负担。
