Chan Hei Kit, Okubo Masashi, Callaway Clifton W, Mann N Clay, Wang Henry E
Department of Emergency Medicine, Department of Biostatistics The University of Texas Health Science Center at Houston Houston Texas USA.
Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA.
J Am Coll Emerg Physicians Open. 2020 Jun 4;1(4):445-452. doi: 10.1002/emp2.12106. eCollection 2020 Aug.
The national incidence and characteristics of out-of-hospital cardiac arrest in the United States is unclear. We sought to describe the national characteristics of adult out-of-hospital cardiac arrest reported in the National Emergency Medical Services Information System (NEMSIS).
We used 2016 NEMSIS data, consisting of most emergency medical services (EMS) responses from 46 states and territories. We limited the analysis to adult (age ≥18 years) emergency "9-1-1" events. We defined out-of-hospital cardiac arrest as: (1) patient condition reported as cardiac arrest, (2) EMS reported attempted resuscitation of cardiac arrest, (3) EMS performance of cardiopulmonary resuscitation (CPR), or (4) EMS performance of defibrillation. We determined the incidence of adult out-of-hospital cardiac arrest among EMS responses. We also determined patient demographics (age, sex, race, ethnicity, location, US census region, and urbanicity), response characteristics (dispatch complaint and elapsed time) and clinical interventions (medications and procedures) of adult out-of-hospital cardiac arrest. We analyzed the data using descriptive techniques, calculating binomial proportions with exact 95% confidence intervals (CI).
Among 18,679,873 adult 9-1-1 responses, there were 224,992 with patient condition cardiac arrest, 344,274 with EMS-reported attempted cardiac arrest resuscitation, 149,775 with EMS performance of CPR, and 185,388 cases with EMS performance of defibrillation, resulting in a total of 574,824 out-of-hospital cardiac arrest (incidence 30.8 per 1000 EMS 9-1-1 responses, 95% CI = 30.69-30.85). Among identified out-of-hospital cardiac arrest responses, most involved patients who were older (mean = 62.4 ± 20.1 years). Most out-of-hospital cardiac arrest occurred at home (58.8%), in the South census region (65.4%), and in urban settings (79.8%). The most commonly reported medications used in out-of-hospital cardiac arrest were: epinephrine (22.5%), amiodarone (2.9%), sodium bicarbonate (6.2%), glucose (3.0%), and naloxone (5.1%). Commonly reported procedures included CPR (26.1%), orotracheal intubation (14.2%), bag-valve-mask ventilation (10.1%), manual defibrillation (29.3%) and automated external defibrillation (5.6%). Out-of-hospital cardiac arrest EMS treatment times were: elapsed response time (median = 7 minutes [interquartile range (IQR) = 5-10]), scene time (median = 17 minutes [IQR = 12-25]), and elapsed transport time (median = 11 minutes [IQR = 6-17]).
Using information available in the 2016 NEMSIS data, we estimate that there were over 570,000 reported adult out-of-hospital cardiac arrests in the United States. These results highlight the challenges of characterizing the epidemiology of adult out-of-hospital cardiac arrest in the United States.
美国院外心脏骤停的全国发病率及特征尚不清楚。我们试图描述国家紧急医疗服务信息系统（NEMSIS）中报告的成人院外心脏骤停的全国特征。
我们使用了2016年NEMSIS数据，该数据包含来自46个州和地区的大多数紧急医疗服务（EMS）响应。我们将分析限于成人（年龄≥18岁）紧急“9-1-1”事件。我们将院外心脏骤停定义为：（1）报告的患者状况为心脏骤停；（2）EMS报告尝试对心脏骤停进行复苏；（3）EMS进行心肺复苏（CPR）；或（4）EMS进行除颤。我们确定了EMS响应中成人院外心脏骤停的发病率。我们还确定了成人院外心脏骤停患者的人口统计学特征（年龄、性别、种族、民族、地点、美国人口普查区域和城市化程度）、响应特征（调度投诉和经过时间）以及临床干预措施（药物和程序）。我们使用描述性技术分析数据，计算具有精确95%置信区间（CI）的二项式比例。
在18,679,873次成人9-1-1响应中，有224,992次患者状况为心脏骤停，344,274次EMS报告尝试对心脏骤停进行复苏，149,775次EMS进行CPR，以及185,388例EMS进行除颤，导致总共574,824次院外心脏骤停（发病率为每1000次EMS 9-1-1响应30.8次，95%CI = 30.69-30.85）。在已确定的院外心脏骤停响应中，大多数涉及年龄较大的患者（平均 = 62.4±20.1岁）。大多数院外心脏骤停发生在家中（58.8%）、南部人口普查区域（65.4%）和城市地区（79.8%）。院外心脏骤停中最常报告使用的药物为：肾上腺素（22.5%）、胺碘酮（2.9%）、碳酸氢钠（6.2%）、葡萄糖（3.0%）和纳洛酮（5.1%）。常见报告的程序包括CPR（26.1%）、气管插管（14.2%）、袋阀面罩通气（10.1%）、手动除颤（29.3%）和自动体外除颤（5.6%）。院外心脏骤停的EMS治疗时间为：响应经过时间（中位数 = 7分钟[四分位间距（IQR） = 5-10]）、现场时间（中位数 = 17分钟[IQR = 12-25]）和转运经过时间（中位数 = 11分钟[IQR = 6-17]）。
利用2016年NEMSIS数据中的可用信息，我们估计美国报告的成人院外心脏骤停超过570,000例。这些结果凸显了描述美国成人院外心脏骤停流行病学特征的挑战。
