改善院外心脏骤停后生存及神经功能转归的时间趋势
Improving Temporal Trends in Survival and Neurological Outcomes After Out-of-Hospital Cardiac Arrest.
作者信息
Buick Jason E, Drennan Ian R, Scales Damon C, Brooks Steven C, Byers Adams, Cheskes Sheldon, Dainty Katie N, Feldman Michael, Verbeek P Richard, Zhan Cathy, Kiss Alex, Morrison Laurie J, Lin Steve
机构信息
From Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (J.E.B., I.R.D., S.C.B., A.B., S.C., K.N.D., C.Z., L.J.M., S.L.); Division of Emergency Medicine, Department of Medicine (J.E.B., I.R.D., S.C.B., A.B., S.C., K.N.D., C.Z., L.J.M., S.L.), Institute of Medical Science (I.R.D.), Institute of Health Policy, Management and Evaluation (D.C.S., J.E.B., K.N.D., A.K., L.J.M., S.L.), Interdepartmental Division of Critical Care, Department of Medicine (D.C.S.), Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), University of Toronto, ON, Canada; Department of Critical Care Medicine (D.C.S.) and Sunnybrook Center for Prehospital Medicine (S.C., M.F., P.R.V.), Sunnybrook Health Sciences Center, Toronto, ON, Canada; and Department of Emergency Medicine, Faculty of Health Sciences, Queens University, Kingston, ON, Canada (S.C.B.).
出版信息
Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e003561. doi: 10.1161/CIRCOUTCOMES.117.003561.
BACKGROUND
Considerable effort has gone into improving outcomes from out-of-hospital cardiac arrest (OHCA). Studies suggest that survival is improving; however, prior studies had insufficient data to pursue the relationship between markers of guideline compliance and temporal trends. The objective of the study was to evaluate trends in OHCA survival over an 8-year period that included the implementation of the 2005 and 2010 international cardiopulmonary resuscitation (CPR) guidelines.
METHODS AND RESULTS
This was a population-based cohort study of all consecutive treated OHCA patients of presumed cardiac cause between 2006 and 2013 in the City of Toronto, Canada, and surrounding regions. Temporal changes were measured by χ trend test. The association between year of the OHCA and survival was evaluated using logistic regression and joinpoint analysis. A total of 23 619 patients with OHCA met study inclusion criteria. During the study period, survival to hospital discharge doubled (4.8% in 2006 to 9.4% in 2013; <0.0001), and survival with good neurological outcome increased (6.2% in 2010 to 8.5% in 2013; =0.005). Improvements occurred in the rates of bystander CPR and automated external defibrillator application, high-quality CPR metrics, and in-hospital targeted temperature management. After adjusting for the Utstein variables, survival to hospital discharge (odds ratio, 1.12; 95% confidence interval, 1.09-1.15) and survival with good neurological outcome (odds ratio, 1.13; 95% confidence interval, 1.05-1.22) increased with each year of study.
CONCLUSIONS
Survival after OHCA has improved over time. This trend was associated with improved rates of bystander CPR, automated external defibrillator use, high-quality CPR metrics, and in-hospital targeted temperature management. The results suggest that multiple factors, each improving over time, may have contributed to the observed increase in survival.
背景
为改善院外心脏骤停（OHCA）的治疗结果已付出了巨大努力。研究表明生存率正在提高；然而，先前的研究缺乏足够的数据来探究指南依从性指标与时间趋势之间的关系。本研究的目的是评估在包括2005年和2010年国际心肺复苏（CPR）指南实施在内的8年期间OHCA生存率的趋势。
方法与结果
这是一项基于人群的队列研究，研究对象为2006年至2013年期间加拿大多伦多市及周边地区所有连续接受治疗的疑似心脏病因的OHCA患者。通过χ趋势检验测量时间变化。使用逻辑回归和连接点分析评估OHCA年份与生存率之间的关联。共有23619例OHCA患者符合研究纳入标准。在研究期间，出院生存率翻倍（2006年为4.8%，2013年为9.4%；P<0.0001），神经功能良好的生存率有所提高（2010年为6.2%，2013年为8.5%；P=0.005）。旁观者心肺复苏和自动体外除颤器应用率、高质量心肺复苏指标以及院内目标温度管理均有所改善。在对Utstein变量进行调整后，出院生存率（比值比，1.12；95%置信区间，1.09-1.15）和神经功能良好的生存率（比值比，1.13；95%置信区间，1.05-1.22）随研究年份的增加而提高。
结论
OHCA后的生存率随时间推移有所提高。这一趋势与旁观者心肺复苏率、自动体外除颤器使用率、高质量心肺复苏指标以及院内目标温度管理的改善有关。结果表明，多个因素随时间推移各自得到改善，可能促成了观察到的生存率提高。
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