Yamashita Akira, Kurosaki Hisanori, Takada Kohei, Tanaka Yoshio, Hamada Yoshitaka, Ishita Tetsuya, Kubo Minoru, Inaba Hideo
Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Department of Cardiology, Noto General Hospital, Nanao, Japan.
Heart Asia. 2019 Aug 19;11(2):e011236. doi: 10.1136/heartasia-2019-011236. eCollection 2019.
To investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA).
From the 2005-2014 nationwide databases, we extracted the data for 1660 schoolchildren (6-17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00.
The neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate.
School hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.
探讨在校时间与院外心脏骤停（OHCA）学龄儿童预后之间的关联。
从2005 - 2014年全国数据库中，我们提取了1660名6 - 17岁有旁观者目睹OHCA的学龄儿童的数据。采用单因素分析，随后进行倾向匹配程序和逐步逻辑回归分析。在校时间定义为08:00至18:00。
仅在上学日，在校时间内神经功能良好的1个月生存率高于非在校时间：分别为18.4%和10.5%。在上学日的在校时间内，OHCA患者更频繁地接受旁观者心肺复苏（CPR）和公众可及除颤（PAD），且初始心律可电击复律且病因推测为心脏原因。倾向评分匹配后，上学日在校时间与一天中所有其他时间的神经功能良好的1个月生存率无显著差异：16.4%对16.1%（未调整OR 1.02；95% CI 0.69至1.51）。上学日在校时间的逐步逻辑回归分析显示，初始心律可电击复律（调整OR 2.44；95% CI 1.12至5.42）、PAD（调整OR 3.32；95% CI 1.23至9.10）、非外部原因（调整OR 5.88；95% CI 1.85至20.0）以及较短的紧急医疗服务（EMS）响应时间（调整OR 1.15；95% CI 1.02至1.32）和目击者至首次CPR间隔（调整OR 1.08；95% CI 1.01至1.15）是与神经功能良好的1个月生存率提高相关的主要因素。
在校时间不是与学龄儿童OHCA预后改善相关的独立因素。上学日在校时间内CPR和EMS到达的时间延迟与不良预后独立相关。
