院外心脏骤停患者的院前高级气道管理效果的变异性
Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest.
作者信息
Oh Young Seok, Ahn Ki Ok, Shin Sang Do, Kagino Kentaro, Nishiuchi Tatsuya, Ma Matthew, Ko Patrick, Ong Marcus Eng Hock, Yng Ng Yih, Leong Benjamin
机构信息
Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
出版信息
Clin Exp Emerg Med. 2020 Jun;7(2):95-106. doi: 10.15441/ceem.19.022. Epub 2020 Jun 30.
OBJECTIVE
To investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities.
METHODS
We enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities.
RESULTS
A total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24-0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06-0.26) and 0.21 (95% CI, 0.16-0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31-1.10] and 0.79 [95% CI, 0.52-1.20], respectively). The interaction between prehospital AAM and region was significant (P=0.01).
CONCLUSION
The effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.
目的
根据亚洲四个城市的区域紧急医疗服务（EMS）系统，调查院外高级气道管理（AAM）对院外心脏骤停（OHCA）患者结局的影响差异。
方法
我们纳入了2012年至2014年间来自日本大阪、韩国首尔、新加坡和中国台北，由EMS治疗的推测为心脏原因的成年OHCA患者。主要暴露变量是院外AAM。主要终点是神经功能恢复。我们使用多变量逻辑回归以及院外AAM与四个亚洲城市之间的交互项，比较了院外AAM组和非AAM组的结局。
结果
最终分析共纳入16510例患者。大阪、首尔、新加坡和台北的院外AAM率各不相同（分别为65.0%、19.2%、84.9%和34.1%）。非AAM组的结局优于AAM组（神经功能恢复的调整优势比[aOR]为0.30；95%置信区间[CI]，0.24 - 0.38）。在神经功能恢复的交互模型中，大阪和新加坡AAM的aOR分别为0.12（95%CI，0.06 - 0.26）和0.21（95%CI，0.16 - 0.28）。在首尔和台北，院外AAM与神经功能恢复之间的关联不显著（aOR分别为0.58[95%CI，0.31 - 1.10]和0.79[95%CI，0.52 - 1.20]）。院外AAM与地区之间的交互作用显著（P = 0.01）。
结论
院外AAM对OHCA患者结局的影响因EMS系统的区域差异而有所不同。
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