Platt Anthony
Yorkshire Ambulance Service NHS Trust.
Br Paramed J. 2020 Jun 1;5(1):32-36. doi: 10.29045/14784726.2020.06.5.1.32.
In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology.
All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data.
478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%).
Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival.
在英国，每年约有60000例院外心脏骤停（OHCA）病例。越来越多的证据表明，对于疑似心脏病因的院外心脏骤停病例，复苏后护理应包括早期血管造影和直接经皮冠状动脉介入治疗（pPCI）。如果复苏后心电图显示有ST段抬高型心肌梗死（STEMI）的证据，约克郡救护车服务（YAS）的工作人员可以将恢复自主循环（ROSC）的患者直接转运至pPCI治疗单元。本服务评估旨在确定影响疑似心脏病因的ROSC患者的转运目的地、医院特征和30天生存率的因素。
回顾了2017年1月至7月期间先前为AIRWAYS - 2试验确定的所有患者护理记录（PCR）。如果患者为成年非创伤性OHCA，在现场实现ROSC，并由（YAS）进行治疗和转运，则符合纳入标准。使用描述性统计分析数据。
478例患者符合纳入标准。361/478（75.6%）的患者记录了复苏后心电图，其中149/361（41.3%）记录为STEMI病例，88/149（59.1%）被主治医生转诊至pPCI治疗单元。转诊的患者中有40/88（45.5%）被pPCI治疗单元接收。与被转运至有pPCI能力医院的急诊科（ED）的患者（34/126，27.0%）或被转运至无pPCI能力医院的急诊科的患者（50/310，16.1%）相比，直接被转运至pPCI治疗单元的患者最有可能存活至30天（25/39，53.8%）。
应鼓励工作人员为所有ROSC患者记录12导联心电图，如果有STEMI证据或可能为心脏病因，则转诊至有区域pPCI能力的中心，因为直接接受pPCI治疗的患者30天生存率最高。救护车服务部门应继续与有区域pPCI能力的中心合作，以确保接收合适的患者，从而最大限度地提高生存潜力。
