Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
Emerg Med Australas. 2020 Aug;32(4):631-637. doi: 10.1111/1742-6723.13490. Epub 2020 Mar 13.
This study aims to present overall survival rates to hospital discharge for out-of-hospital cardiac arrest (OHCA) in Tasmania and to identify predictors of survival.
A retrospective observational cohort study was undertaken from 1 January 2010 to 31 December 2014. A probabilistically linked data set was created from paramedic electronic medical records and hospital patient records. Logistic regression was used to assess factors associated with survival of OHCA.
During the study, 2949 incidents of OHCA were reviewed and 1146 had emergency management provided, with an overall survival rate to hospital discharge of 135 (12%). A number of independent factors are associated with improved outcomes including if the initial presenting cardiac rhythm was either ventricular fibrillation or ventricular tachycardia (adjusted odds ratio [OR] 8.75, 95% confidence interval [CI] 5.15-14.89) (P < 0.0001) relative to those who were found in a non-shockable rhythm. Another factor was age group (overall P < 0.001). Those aged 85+ years had a reduced overall survival rate (2.9%), which was lower than those <16 years of age (OR 0.37, 95% CI 0.07-1.94; adjusted OR 0.38, CI 0.03-1.00) (P < 0.001). The odds of surviving OHCA decreased by 9% for every minute defibrillation of a shockable rhythm was delayed were witnessed by a bystander (OR 0.90, 95% CI 0.85-0.95).
Time to defibrillation for witnessed arrests, other than paramedic witnessed arrest was associated with better overall survival rates than unwitnessed OHCA. Further factors such as the event being of cardiac aetiology, bystander cardio-pulmonary resuscitation performed, initial presenting cardiac rhythm of ventricular fibrillation or ventricular tachycardia and decreasing age were all associated with increased probability of survival.
本研究旨在报告塔斯马尼亚州院外心脏骤停（OHCA）患者出院的总体生存率，并确定生存的预测因素。
本研究为回顾性观察队列研究，时间为 2010 年 1 月 1 日至 2014 年 12 月 31 日。通过概率链接的电子病历和医院患者记录数据集来创建。使用逻辑回归评估与 OHCA 生存相关的因素。
在研究期间，共回顾了 2949 例 OHCA 事件，其中 1146 例接受了紧急管理，出院时总体生存率为 135 例（12%）。许多独立因素与改善预后相关，包括初始呈现的心脏节律是否为室颤或室性心动过速（调整后的优势比[OR]8.75，95%置信区间[CI]5.15-14.89）（P<0.0001），与非电击性节律相比。另一个因素是年龄组（整体 P<0.001）。85 岁以上的患者总体生存率降低（2.9%），低于 16 岁以下的患者（OR 0.37，95%CI 0.07-1.94；调整后的 OR 0.38，CI 0.03-1.00）（P<0.001）。目击者目击除急救人员目击外，每延迟 1 分钟除颤，OHCA 存活的几率降低 9%（OR 0.90，95%CI 0.85-0.95）。
目击者目击除急救人员目击外的除颤时间与未目击 OHCA 相比，与更高的总体生存率相关。进一步的因素，如事件的心脏病因、旁观者心肺复苏的实施、初始呈现的室颤或室性心动过速节律以及年龄下降，均与生存率增加相关。
