决定医院治疗水平的因素及其与院前无脉电活动复苏后结局的关系。
Factors determining level of hospital care and its association with outcome after resuscitation from pre-hospital pulseless electrical activity.
机构信息
FinnHEMS Research and Development Unit and Emergency Medical Service, FinnHEMS 30, Tampere University Hospital, University of Tampere, PO Box 2000, FI-33521, Tampere, Finland.
Emergency Medical Services, Department of Emergency Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
出版信息
Scand J Trauma Resusc Emerg Med. 2018 Nov 19;26(1):98. doi: 10.1186/s13049-018-0568-0.
BACKGROUND
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) with pulseless electrical activity (PEA) as initial cardiac rhythm are not always treated in intensive care units (ICUs): some are admitted to high dependency units with various level of care, others to ordinary wards. Aim of this study was to describe the factors determining level of hospital care after OHCA with PEA, post-resuscitation care and survival.
METHODS
Adult OHCA patients with PEA (n = 221), who were resuscitated in southern Finland between 2010 and 2013 were included, provided patient survived to hospital admission. The patients were divided into four groups according to the level of hospital care provided: ordinary ward and Level 1-3 ICUs. Differences in patient characteristics, post-resuscitation care and survival were compared between the groups.
RESULTS
Most patients (62.4%) were treated at Level 2 ICUs. Longer time to ROSC and advanced age decreased admission rate to Level 2 or 3 post-resuscitation care, whereas good pre-arrest CPC (1-2) increased the admission rate to Level 2/3 ICUs independently. Treatment with targeted temperature management (TTM) (4.1%) or early coronary angiography (3.2%) were very rare. Prognostic decisions were made earlier in the lower treatment intensity groups (p < 0.01). One-year survival rate was 24.0, 17.1% survived with good neurological outcome. Neurological outcome was better with more intensive care. After adjustment, level of care was not independent predictor for outcome: only return of spontaneous circulation (ROSC) time, cardiac arrest cause and pre-arrest performance affected independently to 1-year survival, age and ROSC for neurologic outcome.
CONCLUSIONS
PEA are usually admitted to Level 2 ICUs for post-resuscitation care in the capital area of Finland. Age, ROSC and pre-arrest CPC were independent predictors for level of post-resuscitation care. TTM and early CAG were rare and provided only for Level 3 ICU patients. Prognostication was earlier in lower level of care units. Good neurologic survival was more common with more intensive level of post-resuscitation care. After adjustment, level of care was not independent predictor for survival or neurologic outcome: only ROSC, cardiac arrest cause and pre-arrest performance predicted 1-year survival; age and ROSC neurologic outcome.
背景
以无脉电活动（PEA）作为初始心搏节律从院外心脏骤停（OHCA）复苏的患者并非总是在重症监护病房（ICU）接受治疗：有些患者被收入有不同护理水平的高依赖病房，有些则被收入普通病房。本研究的目的是描述决定 PEA 后 OHCA 患者的医院治疗水平、复苏后护理和生存的因素。
方法
纳入 2010 年至 2013 年在芬兰南部复苏的患有 PEA 的成年 OHCA 患者（n=221），患者须存活至入院。根据提供的医院治疗水平，将患者分为普通病房和 1-3 级 ICU 组。比较各组患者特征、复苏后护理和生存情况的差异。
结果
大多数患者（62.4%）在 2 级 ICU 接受治疗。ROSC 时间延长和年龄较大降低了复苏后接受 2 级或 3 级治疗的入院率，而良好的复苏前 CPC（1-2 级）则独立增加了接受 2/3 级 ICU 治疗的入院率。靶向体温管理（TTM）（4.1%）或早期冠状动脉造影（3.2%）的治疗非常少见。在治疗强度较低的组中，预后决策更早做出（p<0.01）。1 年生存率为 24.0%，17.1%的患者神经功能预后良好。更密集的护理可改善神经预后。调整后，治疗水平不是预后的独立预测因素：只有自主循环恢复（ROSC）时间、心搏骤停原因和复苏前表现独立影响 1 年生存率，年龄和 ROSC 影响神经功能预后。
结论
芬兰首都地区的 PEA 患者通常在 2 级 ICU 接受复苏后护理。年龄、ROSC 和复苏前 CPC 是复苏后治疗水平的独立预测因素。TTM 和早期 CAG 很少见，仅用于 3 级 ICU 患者。预后在治疗水平较低的病房中更早做出。更密集的复苏后护理水平更常见于良好的神经预后。调整后，治疗水平不是生存或神经预后的独立预测因素：只有 ROSC、心搏骤停原因和复苏前表现预测 1 年生存率；年龄和 ROSC 预测神经功能预后。
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