Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung County 833, Taiwan.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung County 833, Taiwan.
Am J Emerg Med. 2021 Aug;46:456-461. doi: 10.1016/j.ajem.2020.10.054. Epub 2020 Oct 27.
Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and a highly variable survival rate. Few studies have focused on outcomes in rural and urban groups while also evaluating underlying diseases and prehospital factors for OHCAs.
To investigate the relationship between the patient's underlying disease and outcomes of OHCAs in urban areas versus those in rural areas.
We reviewed the emergency medical service (EMS) database for information on OHCA patients treated between January 2015 and December 2019, and collected data on pre-hospital factors, underlying diseases, and outcomes of OHCAs. Univariate and multivariate logistic regression analyses were used to evaluate the prognostic factors for OHCA.
Data from 4225 OHCAs were analysed. EMS response time was shorter and the rate of attendance by EMS paramedics was higher in urban areas (p < 0.001 for both). Urban area was a prognostic factor for >24-h survival (odds ratio [OR] = 1.437, 95% confidence interval [CI]: 1.179-1.761). Age (OR = 0.986, 95% CI: 0.979-0.993). EMS response time (OR = 0.854, 95% CI: 0.811-0.898), cardiac arrest location (OR = 2.187, 95% CI: 1.707-2.795), attendance by paramedics (OR = 1.867, 95% CI: 1.483-2.347), and prehospital defibrillation (OR = 2.771, 95% CI: 2.154-3.556) were independent risk factors for survival to hospital discharge, although the influence of an urban area was not significant (OR = 1.211, 95% CI: 0.918-1.584).
Compared with rural areas, OHCA in urban areas are associated with a higher 24-h survival rate. Shorter EMS response time and a higher probability of being attended by paramedics were noted in urban areas. Although shorter EMS response time, younger age, public location, defibrillation by an automated external defibrillator, and attendance by Emergency Medical Technician-paramedics were associated with a higher rate of survival to hospital discharge, urban area was not an independent prognostic factor for survival to hospital discharge in OHCA patients.
院外心脏骤停（OHCA）的预后较差，存活率差异较大。很少有研究同时关注农村和城市人群的结局，并评估 OHCA 的潜在疾病和院前因素。
探讨城市地区与农村地区 OHCA 患者的潜在疾病与结局之间的关系。
我们回顾了 2015 年 1 月至 2019 年 12 月期间接受治疗的 OHCA 患者的急救医疗服务（EMS）数据库信息，并收集了 OHCA 的院前因素、潜在疾病和结局数据。采用单因素和多因素逻辑回归分析评估 OHCA 的预后因素。
共分析了 4225 例 OHCA 数据。城市地区的 EMS 反应时间更短，EMS 护理人员的出勤比例更高（p 值均<0.001）。城市地区是 24 小时以上存活的预后因素（优势比[OR]为 1.437，95%置信区间[CI]：1.179-1.761）。年龄（OR=0.986，95%CI：0.979-0.993）、EMS 反应时间（OR=0.854，95%CI：0.811-0.898）、心脏骤停地点（OR=2.187，95%CI：1.707-2.795）、护理人员出勤（OR=1.867，95%CI：1.483-2.347）和院前除颤（OR=2.771，95%CI：2.154-3.556）是存活至出院的独立危险因素，尽管城市地区的影响并不显著（OR=1.211，95%CI：0.918-1.584）。
与农村地区相比，城市地区的 OHCA 与 24 小时存活率更高相关。城市地区 EMS 反应时间更短，护理人员出勤的可能性更高。尽管 EMS 反应时间较短、年龄较小、公共地点、自动体外除颤器除颤和 EMT-护理人员出勤与出院存活率更高相关，但城市地区并不是 OHCA 患者存活至出院的独立预后因素。
