Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Republic of Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea.
Am J Emerg Med. 2021 Apr;42:161-167. doi: 10.1016/j.ajem.2020.02.018. Epub 2020 Feb 20.
The time dependence of a multi-tier response for out-of-hospital cardiac arrest (OHCA) is unclear. The aim of this study was to evaluate the time-dependent effect of EMS response type in a multi-tiered system on the clinical outcomes of OHCA.
Adult EMS-treated OHCA of presumed cardiac etiology who were not witnessed by EMS between January 2015 and December 2017 were included. The main exposure was EMS response type: single-tier response, early multi-tier response (0-18 min from call to second EMS arrival), and late multi-tier response (19 min from call to second EMS arrival). The primary outcome was good neurologic recovery at the time of discharge from the hospital. Multivariate logistic regression analysis was performed, adjusting for patient-community and prehospital variables.
Among 54,436 patients, 29,995 patients (55.1%), 21,552 patients (39.6%), and 2889 patients (5.3%) were treated by single-tiered EMS, early multi-tiered EMS, and late multi-tiered EMS, respectively. Good neurological recovery and survival to discharge were more frequent in the early multi-tiered response group (6.4% and 9.7%) than in the single-tiered response group (4.8% and 7.5%) or late multi-tiered response group (3.1% and 5.8%). Compared to the single-tiered response group, the early multi-tiered response group was more likely to have good neurological recovery (adjusted OR, 95% CI: 1.15 [1.06-1.26]), but the late multi-tiered response group was less likely to have good neurological recovery (adjusted OR, 95% CI: 0.76 [0.61-0.96]).
In our basic to intermediate-tiered EMS system, early multi-tier response was associated with improved survival and good neurological recovery.
院外心脏骤停（OHCA）的多梯次反应的时间依赖性尚不清楚。本研究旨在评估多层次系统中 EMS 反应类型的时间依赖性对 OHCA 临床结局的影响。
纳入 2015 年 1 月至 2017 年 12 月间 EMS 治疗的、假定为心源性的成人 OHCA 患者，这些患者在 EMS 到达前未被 EMS 目击。主要暴露因素为 EMS 反应类型：单梯次反应、早期多梯次反应（从接到电话到第二次 EMS 到达的 0-18 分钟）和晚期多梯次反应（从接到电话到第二次 EMS 到达的 19 分钟）。主要结局是出院时的良好神经功能恢复。采用多变量逻辑回归分析，调整患者-社区和院前变量。
在 54436 例患者中，分别有 29995 例（55.1%）、21552 例（39.6%）和 2889 例（5.3%）接受了单梯次 EMS、早期多梯次 EMS 和晚期多梯次 EMS 治疗。早期多梯次反应组的良好神经功能恢复和出院存活率（分别为 6.4%和 9.7%）高于单梯次反应组（分别为 4.8%和 7.5%）或晚期多梯次反应组（分别为 3.1%和 5.8%）。与单梯次反应组相比，早期多梯次反应组更有可能实现良好的神经功能恢复（调整后的比值比，95%置信区间：1.15[1.06-1.26]），而晚期多梯次反应组则不太可能实现良好的神经功能恢复（调整后的比值比，95%置信区间：0.76[0.61-0.96]）。
在我们的基本到中级 EMS 系统中，早期多梯次反应与提高生存率和良好的神经功能恢复相关。
