von Vopelius-Feldt Johannes, Perkins Gavin D, Benger Jonathan
Emergency Department, North Bristol NHS Trust, United Kingdom; Emergency Care Research Group, University of the West of England Bristol, United Kingdom.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Resuscitation. 2021 Mar;160:118-125. doi: 10.1016/j.resuscitation.2021.01.024. Epub 2021 Feb 3.
This study examined the association between admission to a cardiac arrest centre and survival to hospital discharge for adults following out-of-hospital cardiac arrest (OHCA).
We undertook a multicentre retrospective observational study of patients transferred to hospital after OHCA of presumed cardiac aetiology in three ambulance services in England. We used propensity score matching to compare rates of survival to hospital discharge in patients admitted to OHCA centres (defined as either 24/7 PPCI availability or >100 OHCA admissions per year) to rates of survival of patients admitted to non-centres.
Between January 2017 and December 2018, 10,650 patients with OHCA were included in the analysis. After propensity score matching, admission to a hospital with 24/7 PPCI availability or a high volume centre was associated with an absolute improvement in survival to hospital discharge of 2.5% and 2.8%, respectively. The corresponding odds ratios and 95% confidence intervals were 1.69 (1.28-2.23) and 1.41 (1.14-1.75), respectively. The results were similar when missing values were imputed. In subgroup analyses, the association between admission to an OHCA centre and improved rates of survival was mainly seen in patients with OHCA due to shockable rhythms, with no or minimal potential benefit for patients with OHCA and asystole as first presenting rhythm.
Following OHCA, admission to a cardiac arrest centre is associated with a moderate improvement in survival to hospital discharge. A corresponding bypass policy would need to consider the resulting increased workload for OHCA centres.
本研究探讨了院外心脏骤停（OHCA）后成人入住心脏骤停中心与存活至出院之间的关联。
我们对英格兰三个急救服务机构中因推测心脏病因导致OHCA后转至医院的患者进行了一项多中心回顾性观察研究。我们使用倾向得分匹配法，比较入住OHCA中心（定义为具备7×24小时直接经皮冠状动脉介入治疗（PPCI）能力或每年OHCA入院人数超过100例）的患者存活至出院的比例与入住非中心医院患者的存活比例。
在2017年1月至2018年12月期间，共有10650例OHCA患者纳入分析。经过倾向得分匹配后，入住具备7×24小时PPCI能力的医院或大容量中心与存活至出院的绝对改善率分别为2.5%和2.8%。相应的比值比和95%置信区间分别为1.69（1.28 - 2.23）和1.41（1.14 - 1.75）。在对缺失值进行插补后，结果相似。在亚组分析中，入住OHCA中心与生存率提高之间的关联主要见于因可电击心律导致OHCA的患者，对于首次表现为无脉电活动或心搏停止的OHCA患者，没有或只有极小的潜在益处。
OHCA后，入住心脏骤停中心与存活至出院的适度改善相关。相应的转运政策需要考虑由此给OHCA中心增加的工作量。
