Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia.
Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Resuscitation. 2018 Jul;128:43-50. doi: 10.1016/j.resuscitation.2018.04.030. Epub 2018 Apr 25.
System-based improvements to the chain of survival have yielded increases in survival from out-of-hospital cardiac arrest (OHCA) in adults. Comparatively little is known about the long-term trends in incidence and survival following paediatric OHCA.
Between 2000 and 2016, we included children aged ≤16 years who suffered a non-traumatic OHCA in the state of Victoria, Australia. Trends in incidence and unadjusted outcomes were assessed using linear regression and a non-parametric test for trend. Multivariable logistic regression with multiple imputation was used to identify arrest factors associated with event survival and survival to hospital discharge.
Of the 1301 paediatric OHCA events attended by emergency medical services (EMS), 948 (72.9%) received an attempted resuscitation. The overall incidence of EMS-attended and EMS-treated events was 6.7 and 4.9 cases per 100,000 person-years, with no significant changes in trend. Although the proportion of cases with OHCA identified in the call and receiving bystander CPR increased over time, EMS response times also increased. Unadjusted event survival rose from 23.3% in 2000 to 33.3% in 2016 (p trend = .007), and survival to hospital discharge rose from 9.4% to 17.7% over the same period (p trend = .04). Increases in survival to hospital discharge were largely driven by initial shockable arrests, which rose from 33.3% in 2000 to 60.0% in 2016 (p trend = .005). Survival after initial shockable arrests was higher if the first shock was delivered by either first responder or public AED compared with paramedics (83.3% vs. 40.0%, p = .04). After adjustment, the odds of event survival and survival to hospital discharge increased independent of baseline characteristics, by 7% (OR 1.07, 95% CI: 1.03, 1.11; p = .001) and 8% (OR 1.08, 95% CI: 1.01, 1.15; p = .02) per study year, respectively.
Survival following paediatric OHCA increased in our region over a 17 year period. This was driven, in part, by improving outcomes for initial shockable arrests.
通过对生存链进行系统改进，提高了成人院外心脏骤停（OHCA）的生存率。相比之下，关于儿科 OHCA 后发病率和生存率的长期趋势知之甚少。
在 2000 年至 2016 年期间，我们纳入了澳大利亚维多利亚州年龄≤16 岁、非创伤性 OHCA 的儿童。使用线性回归和非参数趋势检验评估发病率和未调整结局的趋势。使用多变量逻辑回归和多重插补来确定与事件生存率和住院出院生存率相关的复苏因素。
在接受紧急医疗服务（EMS）治疗的 1301 例儿科 OHCA 事件中，948 例（72.9%）接受了复苏尝试。EMS 治疗和 EMS 治疗事件的总发生率分别为每 100,000 人年 6.7 和 4.9 例，且趋势无显著变化。尽管随着时间的推移，呼叫中识别和接受旁观者心肺复苏的病例比例有所增加，但 EMS 反应时间也有所增加。未经调整的事件生存率从 2000 年的 23.3%上升至 2016 年的 33.3%（趋势 = .007），同期出院生存率从 9.4%上升至 17.7%（趋势 = .04）。出院生存率的提高主要归因于初始可电击除颤的复苏，从 2000 年的 33.3%上升至 2016 年的 60.0%（趋势 = .005）。如果第一电击来自急救人员或公共 AED，而不是护理人员，初始可电击除颤后复苏的生存率更高（83.3%比 40.0%，p = .04）。在调整后，与基线特征无关，事件生存率和出院生存率每年分别增加 7%（OR 1.07，95%CI：1.03，1.11；p = .001）和 8%（OR 1.08，95%CI：1.01，1.15；p = .02）。
在我们的地区，儿科 OHCA 后生存率在 17 年内有所提高。这在一定程度上是由于初始可电击除颤复苏的改善。
