Ohashi-Fukuda N, Fukuda T, Yahagi N
PhD Student, Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Specialist Emergency Physician and Critical Care Specialist, Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, Research Fellow, Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Anaesth Intensive Care. 2017 May;45(3):375-383. doi: 10.1177/0310057X1704500314.
Optimal pre-hospital care for out-of-hospital cardiac arrest (OHCA) caused by respiratory disease may differ from that for OHCA associated with other aetiologies, especially with respect to respiratory management. We aimed to investigate whether pre-hospital advanced airway management (AAM) was associated with favourable outcomes after OHCA caused by intrinsic respiratory disease. This nationwide, population-based, propensity score-matched study of adult patients in Japan with OHCA due to respiratory disease from 1 January 2005 to 31 December 2012 compared patients with and without pre-hospital AAM. The primary outcome was neurologically favourable survival at one month after the OHCA. Of 49,534 eligible patients, 20,458 received pre-hospital AAM and 29,076 did not. In a propensity score-matched cohort (18,483 versus 18,483 patients), the odds of neurologically favourable survival were significantly lower for patients receiving pre-hospital AAM (0.6% versus 1.5%; odds ratio [OR] 0.42 [95% confidence interval {CI} 0.34 to 0.52]). The results from multivariable logistic regression analysis also showed that pre-hospital AAM was significantly associated with a decreased chance of neurologically favourable survival (adjusted OR 0.43 [95% CI 0.35 to 0.52]). Similar findings were observed for one-month survival and pre-hospital return of spontaneous circulation. In subgroup analyses, pre-hospital AAM was associated with poor neurological outcomes, regardless of the type of airway device used (laryngeal mask airway, adjusted OR 0.35 [95% CI 0.19 to 0.57]; oesophageal obturator airway, adjusted OR 0.44 [95% CI 0.35 to 0.55]; and endotracheal tube, adjusted OR 0.47 [95% CI 0.30 to 0.69]). In conclusion, pre-hospital AAM was associated with poor neurological outcome among patients with OHCA caused by intrinsic respiratory disease.
由呼吸系统疾病导致的院外心脏骤停（OHCA）的最佳院前护理可能与由其他病因引起的OHCA不同，尤其是在呼吸管理方面。我们旨在调查院前高级气道管理（AAM）是否与由内在呼吸系统疾病引起的OHCA后的良好预后相关。这项针对2005年1月1日至2012年12月31日期间日本成年OHCA呼吸系统疾病患者的全国性、基于人群的倾向评分匹配研究，比较了接受和未接受院前AAM的患者。主要结局是OHCA后1个月神经功能良好的存活情况。在49534名符合条件的患者中，20458名接受了院前AAM，29076名未接受。在倾向评分匹配队列（18483名患者对18483名患者）中，接受院前AAM的患者神经功能良好存活的几率显著降低（0.6%对1.5%；优势比[OR]0.42[95%置信区间{CI}0.34至0.52]）。多变量逻辑回归分析结果还显示，院前AAM与神经功能良好存活几率降低显著相关（调整后的OR 0.43[95%CI 0.35至0.52]）。在1个月存活和院前自主循环恢复方面也观察到类似结果。在亚组分析中，无论使用何种气道装置（喉罩气道，调整后的OR 0.35[95%CI 0.19至0.57]；食管阻塞气道，调整后的OR 0.44[95%CI 0.35至0.55]；气管内插管，调整后的OR 0.47[95%CI 0.30至0.69]），院前AAM都与不良神经结局相关。总之，对于由内在呼吸系统疾病引起的OHCA患者，院前AAM与不良神经结局相关。
