瑞士院外心脏骤停：急诊部入院时恢复自主循环或正在进行心肺复苏患者的急诊部死亡率预测因素。
Out-of-hospital cardiac arrests in Switzerland: Predictors for emergency department mortality in patients with ROSC or on-going CPR on admission to the emergency department.
作者信息
Sauter Thomas C, Iten Nora, Schwab Patrik R, Hautz Wolf E, Ricklin Meret E, Exadaktylos Aristomenis K
机构信息
Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
Sanitaetspolizei Bern, Emergency Medical Service, Bern, Switzerland.
出版信息
PLoS One. 2017 Nov 16;12(11):e0188180. doi: 10.1371/journal.pone.0188180. eCollection 2017.
BACKGROUND
One of the leading causes of death is out-of-hospital cardiac arrest (OHCA) with an in-hospital mortality of about 70%. To identify predictors for the high mortality of OHCA patients and especially for women, that are considered at high risk for in-hospital mortality, we evaluated one specific setting of in-hospital treatment after OHCA: the emergency department (ED).
METHODS
Retrospective analysis of consecutive ED admissions with OHCA at the Inselspital Bern, Switzerland from 1st June 2012 to 31th Mai 2015. Demographic, preclinical and ED medical data were compared for patient groups with return of circulation (ROSC) and on-going resuscitation (CPR) on admission, as well as for subgroups with and without ED mortality. Predictors for ED mortality were investigated using univariate analysis with logistic regression.
RESULTS
In 354 patients (228 (64.4%) with ROSC; 126 (35.6%) with on-going CPR) we found an overall ED mortality of 28.5% (5.7% ROSC group; 69.8% on-going CPR group). Female gender (OR 7.053 (CI 95% 2.085; 24.853), p = 0.002) and greater age (OR 1.052 (95% CI 1.006-1.101), p = 0.029) were associated with ED mortality in the ROSC but not in the on-going CPR group. Ventricular fibrillation as initially monitored rhythm (OR 0.126 (95% CI 0.027-0.582), p = 0.008) and shorter CPR duration (OR 1.055 (95% CI 1.024;1.088), p = 0.001) were associated with ED survival in patients with ROSC but not in patients with on-going CPR on admission. In ROSC patients a higher lactate and lower pH were associated with mortality (pH: OR 0.009 (CI95% 0.000;0.420), p = 0.016; lactate: OR 1.183 (95% CI 1.037; 1.349), p = 0.013); similar in on-going CPR patients (pH 0.061 (95% CI 0.007, 0.558), p = 0.013, lactate: 1.146 (95% CI 1.041;1.261), p = 0.005).
CONCLUSION
Patients with ROSC who died during ED care were predominantly women and older patients, as well as patients with non-shockable initial heart rhythm and long CPR durations. In patients with on-going CPR on admission, no clinical or demographic predictors for ED mortality were found. Higher lactate and lower pH were predictors in both OHCA groups.
背景
院外心脏骤停（OHCA）是主要死因之一，院内死亡率约为70%。为了确定OHCA患者尤其是被认为院内死亡风险高的女性患者高死亡率的预测因素，我们评估了OHCA后一种特定的院内治疗环境：急诊科（ED）。
方法
对2012年6月1日至2015年5月31日在瑞士伯尔尼因塞尔医院连续收治的OHCA患者进行回顾性分析。比较入院时循环恢复（ROSC）和持续心肺复苏（CPR）患者组以及有和没有ED死亡的亚组的人口统计学、临床前和ED医疗数据。使用逻辑回归单变量分析研究ED死亡的预测因素。
结果
在354例患者中（228例（64.4%）有ROSC；126例（35.6%）持续进行CPR），我们发现总体ED死亡率为28.5%（ROSC组为5.7%；持续CPR组为69.8%）。女性（比值比7.053（95%置信区间2.085；24.853），p = 0.002）和高龄（比值比1.052（95%置信区间1.006 - 1.101），p = 0.029）与ROSC组的ED死亡相关，但与持续CPR组无关。初始监测心律为心室颤动（比值比0.126（95%置信区间0.027 - 0.582），p = 0.008）和较短的CPR持续时间（比值比1.055（95%置信区间1.024；1.088），p = 0.001）与ROSC患者的ED存活相关，但与入院时持续进行CPR的患者无关。在ROSC患者中，较高的乳酸水平和较低的pH值与死亡率相关（pH值：比值比0.009（95%置信区间0.000；0.420），p = 0.016；乳酸：比值比1.183（95%置信区间1.037；1.349），p = 0.013）；持续进行CPR的患者情况类似（pH值0.061（95%置信区间0.007，0.558），p = 0.013，乳酸：1.146（95%置信区间1.
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