The University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States.
Mayo Clinic, Jacksonville, FL, United States.
Resuscitation. 2019 Jan;134:122-126. doi: 10.1016/j.resuscitation.2018.10.019. Epub 2018 Oct 22.
Opioid overdose mortality has increased in North America; however, recent regional trends in the proportion of treated overdose-related out-of-hospital cardiac arrest (OD-OHCA) compared to out-of-hospital cardiac arrest of presumed cardiac etiology (C-OHCA) are largely unknown. Our aim is to assess trends in the prevalence and outcomes of OD-OHCAs compared to C-OHCAs in Arizona.
Statewide, observational study utilizing an Utstein-style database with EMS-first care reports linked with hospital records, and vital statistics data from 2010 to 2015.
There were 21,658 OHCAs during the study period. After excluding non-C-OHCAs, non-OD-OHCAs, and cases missing outcome data, 18,562 cases remained. Of these remaining cases, 17,591 (94.8%) were C-OHCAs and 971 (5.2%) were OD-OHCAs. There was a significant increase in the proportion of OD-OHCAs from 2010, 4.7% (95% CI: 3.9-5.5) to 2015, 6.6% (95% CI: 5.8-7.5). Mean age for OD-OHCAs was 38 years compared to 66 years for C-OHCAs, (p < 0.0001). Initial shockable rhythm was present in 7.1% of OD-OHCAs vs. 22.6% of C-OHCAs (p < 0.0001). Overall survival to discharge in the OD-OHCA group was 18.6% vs. 11.9% in C-OHCA (p < 0.0001). After risk adjustment, we found an aOR of 2.1 (95% CI: 1.8-2.6) for survival in OD-OHCA compared to C-OHCA.
There has been a significant increase in the proportion of OD-OHCAs in Arizona between 2010-2015. OD-OHCA patients were younger, were less likely to present with a shockable rhythm, and more likely to survive than patients with C-OHCA. These data should be considered in prevention and treatment efforts.
在北美，阿片类药物过量死亡人数有所增加；然而，最近关于经治疗的与过量相关的院外心脏骤停（OD-OHCA）与假定心源性院外心脏骤停（C-OHCA）的比例的区域趋势在很大程度上尚不清楚。我们的目的是评估亚利桑那州 OD-OHCA 与 C-OHCA 的患病率和结局趋势。
这是一项利用具有 EMS 首诊护理报告的 utstein 式数据库进行的全州性观察性研究，该数据库与医院记录以及 2010 年至 2015 年的生命统计数据相关联。
在研究期间共发生 21658 例 OHCA。在排除非 C-OHCA、非 OD-OHCA 和缺少结局数据的病例后，剩余 18562 例病例。在这些剩余的病例中，17591 例（94.8%）为 C-OHCA，971 例（5.2%）为 OD-OHCA。OD-OHCA 的比例从 2010 年的 4.7%（95%CI：3.9-5.5）显著增加到 2015 年的 6.6%（95%CI：5.8-7.5）。OD-OHCA 的平均年龄为 38 岁，而 C-OHCA 的平均年龄为 66 岁（p<0.0001）。OD-OHCA 中初始可除颤节律的比例为 7.1%，而 C-OHCA 为 22.6%（p<0.0001）。OD-OHCA 组出院时的总体生存率为 18.6%，而 C-OHCA 组为 11.9%（p<0.0001）。在风险调整后，我们发现与 C-OHCA 相比，OD-OHCA 的生存率的优势比为 2.1（95%CI：1.8-2.6）。
2010-2015 年期间，亚利桑那州 OD-OHCA 的比例显著增加。OD-OHCA 患者年龄较小，更可能出现可除颤节律，且生存率高于 C-OHCA 患者。在预防和治疗工作中应考虑这些数据。
