European Georges Pompidou Hospital (APHP), Emergency Department, Paris, France; Sudden Death Expertise Centre, INSERM U970 (Team 4), Paris, France; Paris Descartes University, Paris, France.
European Georges Pompidou Hospital (APHP), Cardiology Department, Paris, France; Sudden Death Expertise Centre, INSERM U970 (Team 4), Paris, France; Paris Descartes University, Paris, France.
Resuscitation. 2017 Sep;118:63-69. doi: 10.1016/j.resuscitation.2017.06.019. Epub 2017 Jun 23.
As post-cardiac arrest care may influence patients' outcome, characteristics of receiving hospitals should be integrated in the evaluation of survival. We aimed at assessing the influence of care level center on patients' survival at hospital discharge using a regional registry of out-of-hospital cardiac arrest patients (OHCA).
We retrospectively analysed a Utstein and in-hospital data prospectively collected for all non-traumatic OHCA patients, in whom a successful return of spontaneous circulation (ROSC) had been obtained, from a large metropolitan area (Great Paris). Receiving hospitals were categorized in 3 groups as follows: A centers (High-case volume with cath-lab 24/7), B centers (Intermediate-case volume with cath-lab partly available) and C centers (Low-case volume and no cath-lab) We compared patients' characteristics and outcome in the 3 groups and performed a multivariate logistic regression using survival to discharge as primary endpoint.
Between May 2011 and December 2013, 1476 patients were admitted in 48 hospitals (group A: n=917; group B: n=428; group C: n=91). Overall survival rate at discharge was 433/1436 (30%). Patients' baseline characteristics significantly differed, as hospitals from group A received younger patients with a higher rate of shockable cardiac rhythms (p<0.001). Unadjusted survival rate differed significantly among the 3 groups of hospitals (respectively 34%, 25% and 15.4% for A-C, p<0.01). In multivariate analysis, the category of receiving hospital was no longer associated with survival, even in the subgroup of witnessed arrest and shockable patients.
In this population-based study, characteristics of receiving hospitals are not associated with survival rate at discharge. This might be partially explained by the prehospital triage organization used in France.
由于心脏骤停后治疗可能会影响患者的预后，因此在评估存活率时应将接收医院的特点纳入考虑。我们旨在使用区域性院外心脏骤停患者（OHCA）登记处评估心脏骤停后治疗水平中心对患者出院时存活率的影响。
我们回顾性分析了一个来自大巴黎地区（大巴黎）的、经连续及院内数据收集的所有非创伤性 OHCA 患者的 utstein 数据，这些患者均成功恢复自主循环（ROSC）。接收医院分为 3 组：A 中心（高病例量，24/7 设有心导管实验室）、B 中心（中等病例量，部分时间设有心导管实验室）和 C 中心（低病例量，无心导管实验室）。我们比较了 3 组患者的特征和结局，并使用以出院时存活为主要终点的多变量逻辑回归进行分析。
2011 年 5 月至 2013 年 12 月期间，48 家医院收治了 1476 名患者（A 组：917 名；B 组：428 名；C 组：91 名）。出院时的总存活率为 433/1436（30%）。患者的基线特征差异显著，A 组医院收治的患者年龄更小，可电击性心律失常的比例更高（p<0.001）。3 组医院的未调整存活率差异显著（分别为 A-C 组的 34%、25%和 15.4%，p<0.01）。多变量分析中，即使在目击性停搏和可电击性患者亚组中，接收医院的类别也与存活率无关。
在这项基于人群的研究中，接收医院的特点与出院时的存活率无关。这可能部分归因于法国使用的院前分诊组织。
