华盛顿州和北卡罗来纳州心脏救援项目期间城市和非城市院外心脏骤停患者的护理及预后情况。

Care and outcomes of urban and non-urban out-of-hospital cardiac arrest patients during the HeartRescue Project in Washington state and North Carolina.

作者信息

Kragholm Kristian, Hansen Carolina Malta, Dupre Matthew E, Strauss Benjamin, Tyson Clark, Monk Lisa, Pearson David A, Nelson R Darrell, Fosbøl Emil L, Starks Monique, Jollis James G, Shin Jenny, Rea Thomas, McNally Bryan, Granger Christopher B

机构信息

Duke Clinical Research Institute, Durham, NC, USA; Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.

Duke Clinical Research Institute, Durham, NC, USA.

出版信息

Resuscitation. 2020 Jul;152:5-15. doi: 10.1016/j.resuscitation.2020.04.030. Epub 2020 May 8.

DOI:10.1016/j.resuscitation.2020.04.030

PMID:32430288

Abstract

AIM

We examined overall and temporal differences in out-of-hospital cardiac arrest (OHCA) care and outcomes by urban versus non-urban setting separately for North Carolina (NC) and Washington State (WA) during HeartRescue initiatives and associations of urban/non-urban settings with outcome by state.

METHODS

OHCAs of presumed cardiac etiology from counties with complete registry enrollment in NC during 2010-2014 (catchment population = 3,143,809) and WA during 2011-2014 (catchment population = 3,653,506) were identified. Geospatial arrest location data and US Census classification were used to categorize urban areas with ≥50,000 versus non-urban <50,000 people.

RESULTS

Included were 7731 NC cases (78.9% urban) and 4472 WA cases (85.8% urban). Bystander cardiopulmonary resuscitation (CPR) increased from 36.9% (2010) to 50.3% (2014) in NC non-urban areas versus 58.2% (2011) to 69.2% (2014) in WA; and from 39.3% to 51.1% in NC urban areas versus 52.4% to 61.8% in WA. Crude discharge survival odds ratio (OR) was 2.49 (95%CI 1.96-3.16) for urban versus non-urban NC cases not declared dead in field (N = 4241). Adjusted for age, sex, public location, bystander-witness status, time between emergency call and emergency medical service (EMS) arrival, calendar-year, bystander and first-responder CPR and defibrillation and direct PCI-center transport, OR was 1.30 (95%CI 0.98-1.73). In WA, corresponding crude and adjusted ORs were 1.38 (95%CI 0.99-1.93) and 1.46 (95%CI 1.00-2.13). In both states, bystander and first-responder CPR and defibrillation and direct PCI-hospital transport were associated with increased survival.

CONCLUSIONS

During HeartRescue initiatives, bystander CPR increased in urban and non-urban locations. Bystander and first-responder interventions and direct PCI-hospital transport were associated with improved outcomes, including in non-urban areas.

摘要

目的

我们分别考察了北卡罗来纳州（NC）和华盛顿州（WA）在“心脏救援”倡议期间，城市与非城市地区院外心脏骤停（OHCA）护理及结局的总体和时间差异，以及各州城市/非城市地区与结局的关联。

方法

确定了2010 - 2014年北卡罗来纳州（集水区人口 = 3,143,809）和2011 - 2014年华盛顿州（集水区人口 = 3,653,506）中登记完整的县内推测为心脏病因的院外心脏骤停病例。利用地理空间骤停位置数据和美国人口普查分类，将人口≥50,000的城市地区与人口<50,000的非城市地区进行分类。

结果

纳入北卡罗来纳州7731例病例（78.9%为城市地区）和华盛顿州4472例病例（85.8%为城市地区）。北卡罗来纳州非城市地区旁观者心肺复苏（CPR）从2010年的36.9%增至2014年的50.3%，而华盛顿州从2011年的58.2%增至2014年的69.2%；北卡罗来纳州城市地区从39.3%增至51.1%，华盛顿州从52.4%增至61.8%。对于北卡罗来纳州现场未宣布死亡的城市与非城市病例（N = 4241），粗出院生存比值比（OR）为2.49（95%CI 1.96 - 3.16）。在调整年龄、性别、公共场所、旁观者见证状态、紧急呼叫与紧急医疗服务（EMS）到达之间的时间、日历年、旁观者和第一反应者的心肺复苏和除颤以及直接PCI中心转运后，OR为1.30（95%CI 0.98 - 1.73）。在华盛顿州，相应的粗OR和调整后OR分别为1.38（95%CI 0.99 - 1.93）和1.46（95%CI 1.00 - 2.13）。在这两个州，旁观者和第一反应者的心肺复苏和除颤以及直接PCI医院转运均与生存率提高相关。