Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
Resuscitation. 2017 Oct;119:37-42. doi: 10.1016/j.resuscitation.2017.08.001. Epub 2017 Aug 5.
A change in prehospital redirection practice could potentially increase the proportion of E-CPR eligible patients with out-of-hospital cardiac arrest (OHCA) transported to extracorporeal cardiopulmonary resuscitation (E-CPR) capable centers. The objective of this study was to quantify this potential increase of E-CPR candidates transported to E-CPR capable centers.
Adults with non-traumatic OHCA refractory to 15min of resuscitation were selected from a registry of adult OHCA collected between 2010 and 2015 in Montreal, Canada. Using this cohort, three simulation scenarios allowing prehospital redirection to E-CPR centers were created. Stringent eligibility criteria for E-CPR and redirection for E-CPR (e.g. age <60years old, initial shockable rhythm) were used in the first scenario, intermediate eligibility criteria (e.g. age <65years old, at least one shock given) in the second scenario and inclusive eligibility criteria (e.g. age <70years old, initial rhythm ≠ asystole) in the third scenario. All three scenarios were contrasted with equivalent scenarios in which patients were transported to the closest hospital. Proportions were compared using McNemar's test.
The proportion of E-CPR eligible patients transported to E-CPR capable centers increased in each scenario (stringent criteria: 48 [24.5%] vs 155 patients [79.1%], p<0.001; intermediate criteria: 81 [29.6%] vs 262 patients [95.6%], p<0.001; inclusive criteria: 238 [23.9%] vs 981 patients [98.5%], p<0.001).
A prehospital redirection system could significantly increase the number of patients with refractory OHCA transported to E-CPR capable centers, thus increasing their access to this potentially life-saving procedure, provided allocated resources are planned accordingly.
院前重新定向实践的改变可能会增加患有院外心脏骤停（OHCA）且符合体外心肺复苏（E-CPR）条件的患者的比例，并将其转运至 E-CPR 中心。本研究的目的是量化转运至 E-CPR 中心的 E-CPR 候选者的潜在增加。
从 2010 年至 2015 年在加拿大蒙特利尔收集的成人 OHCA 登记处中选择非创伤性 OHCA 且对 15 分钟复苏无反应的成年人。使用该队列，创建了三个允许院前重新定向至 E-CPR 中心的模拟场景。在第一个场景中使用了严格的 E-CPR 纳入标准和重新定向至 E-CPR 的标准（例如，年龄<60 岁，初始可除颤节律），在第二个场景中使用了中等纳入标准（例如，年龄<65 岁，至少给予一次除颤），在第三个场景中使用了包含性纳入标准（例如，年龄<70 岁，初始节律≠心搏停止）。所有三个场景都与将患者转运至最近医院的等效场景进行了对比。使用 McNemar 检验比较比例。
在每个场景中，转运至 E-CPR 中心的 E-CPR 合格患者的比例均增加（严格标准：48[24.5%]例与 155 例患者[79.1%]，p<0.001；中等标准：81[29.6%]例与 262 例患者[95.6%]，p<0.001；包含性标准：238[23.9%]例与 981 例患者[98.5%]，p<0.001）。
院前重新定向系统可以显著增加转运至符合 E-CPR 条件的中心的难治性 OHCA 患者数量，从而增加他们获得这种潜在救命程序的机会，前提是相应地计划了分配的资源。
