Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes Avenue, Suite 400A Iroquois Building, Pittsburgh, PA, USA.
Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine and Sciences, 200 First Street SW, Rochester, MN, USA.
Resuscitation. 2017 Nov;120:31-37. doi: 10.1016/j.resuscitation.2017.08.014. Epub 2017 Aug 26.
Mortality from out-of-hospital cardiac arrest (OHCA) is characterized by substantial regional variation. The Institute of Medicine (IOM) recently recommended enhancing the capabilities of EMS systems to improve outcome. In this study, we analyzed the trend in outcome from ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) OHCA in Rochester, MN. Survival from these forms of arrest is commonly employed as a benchmark of Emergency Medical Services (EMS) system performance.
Using a population-based Utstein-style registry in Rochester, MN where a first responder early defibrillation system is utilized, we evaluated outcome from all EMS-treated VF/pVT arrests and the subgroup of bystander-witnessed VF/pVT from 1991 to 2016. Outcome measurement was neurologically intact survival to discharge, defined as Cerebral Performance Category (CPC) 1 or 2. We divided the 26-year study into three periods: 1991-1997, 1998-2008, and 2009-2016, based on initiation of the first responder system of police officers in 1991 and fire-rescue personnel in 1998, and the latter period for comparison with our previous report in 2009.
We observed 355 all VF/pVT arrests and 292 bystander-witnessed VF/pVT arrests between 1991 and 2016. In 2009-2016, neurologically intact survival to discharge from overall VF/pVT and bystander-witnessed VF/pVT increased to 53.7% and 65.2%, respectively, compared with 39.5% and 43.4% in 1991-1997. Using multivariable analysis, survival significantly increased in 2009-2016 among all VF/pVT arrests (adjusted OR, 3.10; 95% CI, 1.54-6.40) and bystander-witnessed VF/pVT (adjusted OR, 4.28; 95% CI, 2.01-9.50), compared with those in 1991-1997.
We observed a significant improving secular trend in neurologically intact survival from VF/pVT cardiac arrests with a relatively high recent survival rate in this EMS System.
院外心脏骤停（OHCA）的死亡率存在显著的地域差异。美国医学研究所（IOM）最近建议加强急救医疗服务（EMS）系统的能力，以改善预后。在这项研究中，我们分析了明尼苏达州罗切斯特市室颤/无脉性室性心动过速（VF/pVT）OHCA 患者的预后趋势。这些形式的心脏骤停的存活率通常被用作 EMS 系统性能的基准。
利用明尼苏达州罗切斯特市的一个基于人群的乌斯泰因风格注册处，那里使用了第一响应者早期除颤系统，我们评估了 1991 年至 2016 年期间所有接受 EMS 治疗的 VF/pVT 骤停患者的预后，以及旁观者目击的 VF/pVT 亚组患者的预后。预后测量是神经功能完整的存活出院，定义为脑功能分类（CPC）1 或 2 级。我们将 26 年的研究分为三个时期：1991-1997 年、1998-2008 年和 2009-2016 年，这是基于 1991 年第一响应者系统启动，1998 年消防员开始使用，以及后期与我们之前在 2009 年的报告进行比较。
我们观察了 1991 年至 2016 年期间的 355 例全 VF/pVT 骤停和 292 例旁观者目击的 VF/pVT 骤停。2009-2016 年，全 VF/pVT 和旁观者目击的 VF/pVT 的神经功能完整存活出院率分别提高到 53.7%和 65.2%，而 1991-1997 年分别为 39.5%和 43.4%。多变量分析显示，与 1991-1997 年相比，2009-2016 年全 VF/pVT 骤停（调整后的比值比，3.10；95%置信区间，1.54-6.40）和旁观者目击的 VF/pVT（调整后的比值比，4.28；95%置信区间，2.01-9.50）的存活率显著增加。
我们观察到，在这个 EMS 系统中，VF/pVT 心脏骤停患者的神经功能完整存活的预后有显著的改善趋势，近期存活率相对较高。
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