Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.
Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan.
J Am Heart Assoc. 2020 Jun 2;9(11):e015544. doi: 10.1161/JAHA.119.015544. Epub 2020 May 27.
Background Should all out-of-hospital cardiac arrest (OHCA) patients be directly transported to cardiac arrest centers (CACs) remains under debate. Our study evaluated the impacts of different transport time and destination hospital on the outcomes of OHCA patients. Methods and Results Data were collected from 6655 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City, Taiwan, between January 2012 and December 2016. Patients were matched on propensity score, which left 5156 patients, 2578 each in the CAC and non-CAC groups. Transport time was dichotomized into <8 and ≥8 minutes. The relations between the transport time to CACs and good neurological outcome at discharge and survival to discharge were investigated. Of the 5156 patients, 4215 (81.7%) presented with nonshockable rhythms and 941 (18.3%) presented with shockable rhythms. Regardless of transport time, transportation to a CAC increased the likelihoods of survival to discharge (<8 minutes: adjusted odds ratio [aOR], 1.95; 95% CI, 1.11-3.41; ≥8 minutes: aOR, 1.92; 95% CI, 1.25-2.94) and good neurological outcome at discharge (<8 minutes: aOR, 2.70; 95% CI, 1.40-5.22; ≥8 minutes: aOR, 2.20; 95% CI, 1.29-3.75) in OHCA patients with shockable rhythms but not in patients with nonshockable rhythms. Conclusions OHCA patients with shockable rhythms transported to CACs demonstrated higher probabilities of survival to discharge and a good neurological outcome at discharge. Direct ambulance delivery to CACs should thus be considered, particularly when OHCA patients present with shockable rhythms.
背景 所有院外心脏骤停（OHCA）患者是否都应直接送往心脏骤停中心（CAC）仍存在争议。我们的研究评估了不同转运时间和目的地医院对 OHCA 患者结局的影响。
方法和结果 数据来自台湾桃园市区域前瞻性 OHCA 登记数据库中 2012 年 1 月至 2016 年 12 月记录的 6655 例 OHCA 患者。根据倾向评分对患者进行匹配，最终留下 5156 例患者，CAC 组和非 CAC 组各 2578 例。将转运时间分为<8 分钟和≥8 分钟。研究了到达 CAC 的转运时间与出院时良好神经功能结局和出院时存活之间的关系。在 5156 例患者中，4215 例（81.7%）呈现非可除颤节律，941 例（18.3%）呈现可除颤节律。无论转运时间如何，将患者转运至 CAC 都增加了出院时存活（<8 分钟：调整后的优势比[aOR]，1.95；95%置信区间[CI]，1.11-3.41；≥8 分钟：aOR，1.92；95% CI，1.25-2.94）和出院时良好神经功能结局（<8 分钟：aOR，2.70；95% CI，1.40-5.22；≥8 分钟：aOR，2.20；95% CI，1.29-3.75）的可能性，在呈现可除颤节律的 OHCA 患者中，但在呈现非可除颤节律的患者中则不然。
结论 呈现可除颤节律的 OHCA 患者转运至 CAC 后，出院时存活和神经功能良好的可能性更高。因此，应考虑直接将救护车送往 CAC，特别是当 OHCA 患者呈现可除颤节律时。
