Hermel Melody, Bosson Nichole, Fang Andrea, French William J, Niemann James T, Sung Gene, Thomas Joseph L, Shavelle David M
Division of Cardiology University of Southern California Los Angeles CA.
Los Angeles County Emergency Medical Service Agency Santa Fe Springs CA.
J Am Heart Assoc. 2020 Dec 15;9(24):e016652. doi: 10.1161/JAHA.120.016652. Epub 2020 Dec 2.
Background Despite the benefits of targeted temperature management (TTM) for out-of-hospital cardiac arrest), implementation within the United States remains low. The objective of this study was to evaluate the prevalence and factors associated with TTM use in a large, urban-suburban regional system of care. Methods and Results This was a retrospective analysis from the Los Angeles County regional cardiac system of care serving a population of >10 million residents. All adult patients aged ≥18 years with non-traumatic out-of-hospital cardiac arrest transported to a cardiac arrest center from April 2011 to August 2017 were included. Patients awake and alert in the emergency department and patients who died in the emergency department before consideration for TTM were excluded. The primary outcome measure was prevalence of TTM use. The secondary analysis were annual trends in TTM use over the study period and factors associated with TTM use. The study population included 8072 patients; 4154 patients (51.5%) received TTM and 3767 patients (46.7%) did not receive TTM. Median age was 67 years, 4780 patients (59.2%) were men, 4645 patients (57.5%) were non-White, and the most common arrest location was personal residence in 4841 patients (60.0%). In the adjusted analysis, younger age, male sex, an initial shockable rhythm, witnessed arrest, and receiving coronary angiography were associated with receiving TTM. Conclusions Within this regional system of care, use of TTM was higher than previously reported in the literature at just over 50%. Use of integrated systems of care may be a novel method to increase TTM use within the United States.
背景 尽管目标温度管理（TTM）对院外心脏骤停有益，但在美国的实施率仍然很低。本研究的目的是评估在一个大型城市-郊区区域护理系统中TTM使用的患病率及相关因素。方法与结果 这是一项对洛杉矶县区域心脏护理系统的回顾性分析，该系统服务于超过1000万居民。纳入了2011年4月至2017年8月间所有年龄≥18岁、非创伤性院外心脏骤停且被转运至心脏骤停中心的成年患者。排除在急诊科清醒且警觉的患者以及在考虑进行TTM之前于急诊科死亡的患者。主要结局指标是TTM使用的患病率。次要分析是研究期间TTM使用的年度趋势以及与TTM使用相关的因素。研究人群包括8072例患者；4154例患者（51.5%）接受了TTM，3767例患者（46.7%）未接受TTM。中位年龄为67岁，4780例患者（59.2%）为男性，4645例患者（57.5%）为非白人，最常见的骤停地点是私人住宅，有4841例患者（60.0%）。在多因素分析中，年龄较小、男性、初始可电击心律、目睹的骤停以及接受冠状动脉造影与接受TTM相关。结论 在这个区域护理系统中，TTM的使用率高于文献中先前报道的略高于50%。使用综合护理系统可能是一种在美国提高TTM使用率的新方法。
