Yoshimura Satoshi, Hirayama Atsushi, Kiguchi Takeyuki, Irisawa Taro, Yamada Tomoki, Yoshiya Kazuhisa, Park Changhwi, Nishimura Tetsuro, Ishibe Takuya, Yagi Yoshiki, Kishimoto Masafumi, Inoue Toshiya, Hayashi Yasuyuki, Sogabe Taku, Morooka Takaya, Sakamoto Haruko, Suzuki Keitaro, Nakamura Fumiko, Matsuyama Tasuku, Okada Yohei, Nishioka Norihiro, Kobayashi Daisuke, Matsui Satoshi, Kimata Shunsuke, Shimazu Takeshi, Kitamura Tetsuhisa, Iwami Taku
Department of Preventive Services, Kyoto University School of Public Health.
Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine.
Circ J. 2021 Sep 24;85(10):1851-1859. doi: 10.1253/circj.CJ-20-1022. Epub 2021 Feb 2.
The aim of our study was to investigate in detail the temporal trends in in-hospital characteristics, actual management, and survival, including neurological status, among adult out-of-hospital cardiac arrest (OHCA) patients in recent years.
From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all OHCA patients aged ≥18 years for whom resuscitation was attempted, and who were transported to participating hospitals between the years 2013 and 2017. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. Temporal trends in in-hospital management and favorable neurological outcome among adult OHCA patients were assessed. Of the 11,924 patients in the database, we included a total of 10,228 adult patients from 16 hospitals. As for in-hospital advanced treatments, extracorporeal cardiopulmonary resuscitation (ECPR) use increased from 2.4% in 2013 to 4.3% in 2017 (P for trend <0.001). However, the proportion of adult OHCA patients with favorable neurological outcome did not change during the study period (from 5.7% in 2013 to 4.4% in 2017, adjusted odds ratio (OR) for 1-year increment: 0.98 (95% confidence interval: 0.94-1.23)).
In this target population, in-hospital management such as ECPR increased slightly between 2013 and 2017, but 1-month survival with favorable neurological outcome after adult OHCA did not improve significantly.
我们研究的目的是详细调查近年来院外心脏骤停（OHCA）成年患者的院内特征、实际治疗情况及生存情况，包括神经功能状态。
我们从日本大阪的院外心脏骤停生存重症监护综合登记（CRITICAL）研究的前瞻性数据库中，纳入了所有年龄≥18岁且尝试进行复苏、并于2013年至2017年间被转运至参与研究医院的OHCA患者。主要结局指标是OHCA后1个月存活且神经功能良好。评估了成年OHCA患者的院内治疗情况及神经功能良好的时间趋势。数据库中的11924例患者中，我们共纳入了来自16家医院的10228例成年患者。关于院内高级治疗，体外心肺复苏（ECPR）的使用从2013年的2.4%增至2017年的4.3%（趋势P<0.001）。然而，成年OHCA患者神经功能良好的比例在研究期间未发生变化（从2013年的5.7%降至2017年的4.4%，每年增加的校正比值比（OR）：0.98（95%置信区间：0.94-1.23））。
在该目标人群中，2013年至2017年间，诸如ECPR等院内治疗略有增加，但成年OHCA后1个月存活且神经功能良好的情况并未显著改善。
