白天入院与儿科院外心脏骤停患者 1 个月生存率的提高相关：日本全国多中心观察性研究分析。
Daytime admission is associated with higher 1-month survival for pediatric out-of-hospital cardiac arrest: Analysis of a nationwide multicenter observational study in Japan.
机构信息
Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
Department of Emergency Medicine, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
出版信息
PLoS One. 2021 Feb 10;16(2):e0246896. doi: 10.1371/journal.pone.0246896. eCollection 2021.
OBJECTIVE
Hospital characteristics, such as hospital type and admission time, have been reported to be associated with survival in adult out-of-hospital cardiac arrest (OHCA) patients. However, findings regarding the effects of hospital types on pediatric OHCA patients have been limited. The aim of this study was to analyze the relationship between the hospital characteristics and the outcomes of pediatric OHCA patients.
METHODS
This study was a retrospective secondary analysis of the Japanese Association for Acute Medicine-out-of-hospital cardiac arrest registry. The period of this study was from 1 June 2014 to 31 December 2015. We enrolled all pediatric patients (those 0-17 years of age) experiencing OHCA in this study. We enrolled all types of OHCA. The primary outcome of this study was 1-month survival after the onset of cardiac arrest.
RESULTS
We analyzed 310 pediatric patients (those 0-17 years of age) with OHCA. In survivors, the rate of witnessed arrest and daytime admission was significantly higher than nonsurvivors (56% vs. 28%, p < 0.001: 49% vs. 31%; p = 0.03, respectively). The multiple logistic regression model showed that daytime admission was related to 1-month survival (odds ratio, OR: 95% confidence interval, CI, 3.64: 1.23-10.80) (p = 0.02). OHCA of presumed cardiac etiology and witnessed OHCA were associated with higher 1-month survival. (OR: 95% CI, 3.92: 1.23-12.47, and 6.25: 1.98-19.74, respectively). Further analyses based on the time of admission showed that there were no significant differences in the proportions of patients with witnessed arrest and who received bystander cardiopulmonary resuscitation and emergency medical service response time by admission time.
CONCLUSION
Pediatric OHCA patients who were admitted during the day had a higher 1-month survival rate after cardiac arrest than patients who were admitted at night.
目的
医院特征，如医院类型和入院时间，与成人院外心脏骤停（OHCA）患者的生存率有关。然而，关于医院类型对儿科 OHCA 患者影响的研究结果有限。本研究旨在分析医院特征与儿科 OHCA 患者结局之间的关系。
方法
本研究是对日本急救医学会院外心脏骤停登记处的回顾性二次分析。本研究的时间段为 2014 年 6 月 1 日至 2015 年 12 月 31 日。我们纳入了所有在该研究中经历 OHCA 的儿科患者（0-17 岁）。我们纳入了所有类型的 OHCA。本研究的主要结局是心脏骤停发作后 1 个月的生存率。
结果
我们分析了 310 例儿科 OHCA 患者（0-17 岁）。在幸存者中，目击性骤停和日间入院的比例显著高于非幸存者（56%比 28%，p<0.001；49%比 31%，p=0.03）。多因素逻辑回归模型显示，日间入院与 1 个月生存率相关（优势比，95%置信区间，CI，3.64:1.23-10.80）（p=0.02）。OHCA 推测为心源性和目击 OHCA 与较高的 1 个月生存率相关（OR：95%CI，3.92:1.23-12.47，6.25:1.98-19.74）。基于入院时间的进一步分析表明，目击性骤停的患者比例和接受旁观者心肺复苏和紧急医疗服务反应时间在不同入院时间之间没有显著差异。
结论
与夜间入院的患者相比，日间入院的儿科 OHCA 患者心脏骤停后 1 个月的生存率更高。
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