Granfeldt Asger, Wissenberg Mads, Hansen Steen Møller, Lippert Freddy K, Torp-Pedersen Christian, Christensen Erika Frischknecht, Christiansen Christian Fynbo
Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Resuscitation. 2017 May;114:113-120. doi: 10.1016/j.resuscitation.2017.02.026. Epub 2017 Mar 6.
Cardiac arrest in a private location is associated with a higher mortality when compared to public location. Past studies have not accounted for pre-arrest factors such as chronic disease and medication.
To investigate whether the association between cardiac arrest in a private location and a higher mortality can be explained by differences in chronic diseases and medication.
We identified 27,771 out-of-hospital cardiac arrest patients ≥18 years old from the Danish Cardiac Arrest Registry (2001-2012). Using National Registries, we identified pre-arrest chronic disease and medication. To investigate the importance of cardiac arrest related factors and chronic disease and medication use we performed adjusted Cox regression analyses during day 0-7 and day 8-365 following cardiac arrest to calculate hazard ratios (HR) for death.
Day 0-7: Un-adjusted HR for death day 0-7 was 1.21 (95%CI:1.18-1.25) in private compared to public location. When including cardiac arrest related factors HR for death was 1.09 (95%CI:1.06-1.12). Adding chronic disease and medication to the analysis changed HR for death to 1.08 (95%CI:1.05-1.12). 8-365 day: The un-adjusted HR for death day 8-365 was 1.70 (95% CI: 1.43-2.02) in private compared to public location. When including cardiac arrest related factors the HR decreased to 1.39 (95% CI: 1.14-1.68). Adding chronic disease and medication to the analysis changed HR for death to 1.27 (95% CI:1.04-1.54).
The higher mortality following cardiac arrest in a private location is partly explained by a higher prevalence of chronic disease and medication use in patients surviving until day 8.
与公共场所相比，私人场所发生的心搏骤停与更高的死亡率相关。既往研究未考虑诸如慢性病和药物治疗等心搏骤停前因素。
调查私人场所心搏骤停与更高死亡率之间的关联是否可由慢性病和药物治疗的差异来解释。
我们从丹麦心搏骤停登记处（2001 - 2012年）确定了27771例年龄≥18岁的院外心搏骤停患者。利用国家登记处的数据，我们确定了心搏骤停前的慢性病和药物治疗情况。为了研究心搏骤停相关因素以及慢性病和药物治疗的重要性，我们在心脏骤停后的第0 - 7天和第8 - 365天进行了校正的Cox回归分析，以计算死亡风险比（HR）。
第0 - 7天：与公共场所相比，私人场所第0 - 7天死亡的未校正HR为1.21（95%CI：1.18 - 1.25）。纳入心搏骤停相关因素后，死亡HR为1.09（95%CI：1.06 - 1.12）。将慢性病和药物治疗纳入分析后，死亡HR变为1.08（95%CI：1.05 - 1.12）。第8 - 365天：与公共场所相比，私人场所第8 - 365天死亡的未校正HR为1.70（95%CI：1.43 - 2.02）。纳入心搏骤停相关因素后，HR降至1.39（95%CI：1.14 - 1.68）。将慢性病和药物治疗纳入分析后，死亡HR变为1.27（95%CI：1.04 - 1.54）。
私人场所心搏骤停后较高的死亡率部分可由存活至第8天的患者中较高的慢性病患病率和药物治疗使用率来解释。
