根据发生时间的不同，院外心搏骤停的特征和结局。
Characteristics and outcomes of out-of-hospital sudden cardiac arrest according to the time of occurrence.
机构信息
Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology department, Paris, France; Sudden Death Expertise Center, Paris, France.
Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology department, Paris, France; Sudden Death Expertise Center, Paris, France.
出版信息
Resuscitation. 2017 Jul;116:16-21. doi: 10.1016/j.resuscitation.2017.04.024. Epub 2017 Apr 27.
PURPOSE
The impact of time of occurrence has been extensively evaluated for in-hospital cardiac arrests but less for Out-of-Hospital Cardiac Arrests (OHCA). We assessed the impact of the time of occurrence on the characteristics and prognosis of OHCA.
METHODS
Using data from the Paris Sudden Cardiac Death Expertise Center prospective study that includes all OHCA in the Paris Area, we compared characteristics and outcomes of off-hours OHCA (nights and days off) to regular-hours OHCA between 2011 and 2014.
RESULTS
Among a total of 9834 OHCA (70.0±17years old, 62.1% males), off-hours OHCA accounted for 63.4%. Although bystanders were more often present (74.4 vs. 72.1%, P=0.01), rates of bystander CPR (46.7 vs. 50.6%, P=0.001) and AED use (1.0 vs. 1.9%, P=0.01) were lower during off-hours. While EMS arrival delays were similar, patients were less often in shockable rhythm (16.3 vs. 19.1%, P<0.0001), and return of spontaneous circulation was less frequent (27.5 vs. 31.1%, P<0.0001). There was no difference in rates of targeted temperature control (54.8 vs. 54.7%, P=0.75), coronary angiography (57.3 vs. 58.2%, P=0.68) and angioplasty use (32.2 vs. 35.6%, P=0.22). Survival at hospital discharge was lower (4.7 vs. 6.5%, P<0.0001) during off-hours. After adjusting for potential confounders, time of occurrence was not associated with worse outcome (OR 0.85, 95% CI 0.69-1.06, P=0.15), and bystander-initiated CPR, shockable initial rhythm and AED use were the main survival predictors (P<0.0001).
CONCLUSION
Off-hours OHCA have a 30% lower survival rate, mainly due to differences in initial management (bystander CPR and AED use), illustrating the need to improve bystanders' responsiveness in all circumstances.
目的
发生时间的影响已在院内心脏骤停中得到广泛评估，但在院外心脏骤停（OHCA）中评估较少。我们评估了发生时间对 OHCA 特征和预后的影响。
方法
使用来自巴黎突发心脏死亡专家中心前瞻性研究的数据，该研究包括巴黎地区所有 OHCA，我们比较了 2011 年至 2014 年夜间和休息日（夜间和休息日）与常规时间 OHCA 的特征和结局。
结果
在总共 9834 例 OHCA（70.0±17 岁，62.1%为男性）中，夜间 OHCA 占 63.4%。尽管旁观者更常见（74.4%比 72.1%，P=0.01），旁观者 CPR（46.7%比 50.6%，P=0.001）和 AED 使用（1.0%比 1.9%，P=0.01）的比例较低。尽管 EMS 到达延迟相似，但患者更不可能出现可除颤节律（16.3%比 19.1%，P<0.0001），自主循环恢复的频率较低（27.5%比 31.1%，P<0.0001）。目标温度控制（54.8%比 54.7%，P=0.75）、冠状动脉造影（57.3%比 58.2%，P=0.68）和血管成形术使用率（32.2%比 35.6%，P=0.22）无差异。夜间出院生存率较低（4.7%比 6.5%，P<0.0001）。在调整了潜在混杂因素后，发生时间与较差的预后无关（OR 0.85，95%CI 0.69-1.06，P=0.15），旁观者启动的 CPR、可除颤初始节律和 AED 使用是主要的生存预测因素（P<0.0001）。
结论
夜间 OHCA 的生存率低 30%，主要是由于初始管理（旁观者 CPR 和 AED 使用）的差异所致，这表明需要在任何情况下提高旁观者的反应能力。
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