Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Prahran, Victoria, Australia.
Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia.
Resuscitation. 2018 Feb;123:65-70. doi: 10.1016/j.resuscitation.2017.12.019. Epub 2017 Dec 16.
Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear.
Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge.
A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8%) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25min (interquartile range [IQR] 9-89min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30min increase in patient delay time was independently associated with a 2.3% (95% CI: 0.4%, 4.1%; p=0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30min increase in patient delay time was associated with a 3.4% reduction in the odds of survival (OR 0.966, 95% CI: 0.937, 0.996; p=0.03).
Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA.
尽管患者自出现症状至激活紧急医疗服务（EMS）之间的时间延长可能导致急性心肌梗死患者的预后较差，但在院外心脏骤停（OHCA）患者中其影响尚不清楚。
2003 年 1 月 1 日至 2011 年 12 月 31 日期间，我们纳入了来自维多利亚救护车心脏骤停登记处的伴有胸痛预警症状且随后由 EMS 见证的推定心源性 OHCA 的成年患者。采用多变量逻辑回归评估患者延迟时间（即症状发作至 EMS 呼叫时间）对出院生存率的影响。
共筛选出 1056 例由 EMS 见证的 OHCA，其中 515 例（48.8%）报告有胸痛或心绞痛等效症状。中位患者延迟时间为 25 分钟（四分位间距[IQR]：9-89 分钟），幸存者和非幸存者之间无差异。然而，在患者延迟时间最低四分位数（≤8 分钟）的患者中，无除颤性心律失常和循环衰竭的发生率也显著更高。在出院生存率的多变量模型中，共检验了 16 个基线和临床特征，其中只有 6 个保留在最终模型中，包括：年龄、呼吸困难、呕吐、可除颤性心律失常、收缩压和患者延迟时间。患者延迟时间每增加 30 分钟，出院生存率独立降低 2.3%（95%CI：0.4%，4.1%；p=0.02）。在预除颤心电图有 ST 段偏移的患者中，患者延迟时间每增加 30 分钟，生存率降低 3.4%（OR 0.966，95%CI：0.937，0.996；p=0.03）。
在 OHCA 发作前激活 EMS 的时间延迟增加可能与生存率降低有关。未来的研究可以探讨增加公众对预警症状的认识是否会导致 OHCA 的医疗接触更早。
