养老院院外心脏骤停后患者的生存情况——一项全国性研究。
Survival after out-of-hospital cardiac arrest in nursing homes - A nationwide study.
机构信息
Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
出版信息
Resuscitation. 2018 Apr;125:90-98. doi: 10.1016/j.resuscitation.2018.02.004. Epub 2018 Feb 7.
BACKGROUND
Survival among nursing home residents who suffers out-of-hospital cardiac arrest (OHCA) is sparsely studied. Deployment of automated external defibrillators (AEDs) in nursing home facilities in Denmark is unknown. We examined 30-day survival following OHCA in nursing and private home residents.
METHODS
This register-based, nationwide, follow-up study identified OHCA-patients ≥18 years of age with a resuscitation attempt in nursing homes and private homes using Danish Cardiac Arrest Register data from June 1, 2001 to December 31, 2014. The primary outcome measure was 30-day survival. Multiple logistic regression analyses were used to assess factors potentially associated with survival among nursing and private home residents separately.
RESULTS
Of 26,999 OCHAs, 2516 (9.3%) occurred in nursing homes, and 24,483 (90.7%) in private homes. Nursing home residents were older (median 83 (Q1-Q3: 75-89) vs. 71 (Q1-Q3: 61-80) years), had more witnessed arrest (55.4% vs. 43.4%), received more bystander cardiopulmonary resuscitation (CPR) (49.7% vs. 35.3%), but less pre-hospital defibrillation (15.1% vs. 29.8%). Registered AEDs increased in the period 2007-2014 from 1 to 211 in nursing homes vs. 1 to 488 in private homes. Average 30-day survival in nursing homes was 1.7% [95%CI: 1.2-2.2%] vs. 4.9% [95%CI: 4.6-5.2%] in private homes (P < 0.001). If bystanders witnessed the arrest, performed CPR, and pre-hospital defibrillation was performed, 30-day survival was 7.7% [95%CI: 3.5-11.9%] vs. 24.2% [95%CI: 22.5-25.9%] in nursing vs. private home residents.
CONCLUSIONS
Average 30-day survival after OHCA was very low in nursing home residents, but those who received early resuscitative efforts had higher chance of survival.
背景
在养老院居民中，院外心脏骤停（OHCA）的生存率研究甚少。丹麦养老院设施中自动体外除颤器（AED）的部署情况尚不清楚。我们研究了养老院和私人住宅居民 OHCA 后的 30 天生存率。
方法
这是一项基于登记的全国性随访研究，使用丹麦心脏骤停登记数据，从 2001 年 6 月 1 日至 2014 年 12 月 31 日，确定了年龄在 18 岁及以上、在养老院和私人住宅中有复苏尝试的 OHCA 患者。主要观察指标为 30 天生存率。采用多因素逻辑回归分析分别评估与养老院和私人住宅居民生存相关的潜在因素。
结果
在 26999 例 OHCA 中，2516 例（9.3%）发生在养老院，24483 例（90.7%）发生在私人住宅。养老院居民年龄较大（中位数 83[Q1-Q3：75-89]岁 vs. 71[Q1-Q3：61-80]岁），目击性逮捕率较高（55.4% vs. 43.4%），旁观者心肺复苏术（CPR）接受率较高（49.7% vs. 35.3%），但院外除颤率较低（15.1% vs. 29.8%）。2007-2014 年期间，养老院登记的 AED 从 1 台增加到 211 台，私人住宅从 1 台增加到 488 台。养老院的平均 30 天生存率为 1.7%[95%CI：1.2-2.2%]，私人住宅为 4.9%[95%CI：4.6-5.2%]（P<0.001）。如果旁观者目击了逮捕，进行了 CPR，并且进行了院外除颤，那么养老院居民的 30 天生存率为 7.7%[95%CI：3.5-11.9%]，私人住宅居民的生存率为 24.2%[95%CI：22.5-25.9%]。
结论
养老院居民 OHCA 后 30 天平均生存率非常低，但接受早期复苏治疗的患者生存率较高。
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