院外心脏骤停患者未经急救医疗服务复苏尝试的时间趋势。
Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services.
机构信息
European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).
Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).
出版信息
Circ Cardiovasc Qual Outcomes. 2021 Mar;14(3):e006626. doi: 10.1161/CIRCOUTCOMES.120.006626. Epub 2021 Mar 12.
BACKGROUND
Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS.
METHODS
Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units.
RESULTS
Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05-1.06], <0.001), female sex (odds ratio, 1.21 [95% CI, 1.10-1.32], =0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86-4.01], <0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74-2.16], <0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, =0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, =0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, =0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, =0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, =0.17).
CONCLUSIONS
We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.
背景
有报道称，院外心脏骤停（OHCA）患者的生存率有显著提高；然而，这些数据仅基于由急救医疗服务（EMS）启动复苏的 OHCA 数据。我们旨在评估 EMS 未尝试复苏的 OHCA 的特征和时间趋势。
方法
这是一项在大巴黎地区（670 万居民）进行的 2011 年至 2016 年期间的前瞻性基于人群的研究。与 EMS 单位、48 家不同的医院和法医单位合作，纳入所有 OHCA 病例。
结果
在 15207 例 OHCA（平均年龄 70.7±16.9 岁，61.6%为男性）中，5486 例（36.1%）未接受 EMS 复苏尝试。与 EMS 未尝试复苏的可能性增加独立相关的因素包括：患者年龄（每增加 1 岁，比值比[OR]为 1.06[95%CI，1.05-1.06]，<0.001）、女性（OR，1.21[95%CI，1.10-1.32]，=0.002）、院外心脏骤停（OR，3.38[95%CI，2.86-4.01]，<0.001）和旁观者缺失（OR，1.94[95%CI，1.74-2.16]，<0.001）。总的来说，OHCA 的年发生率增加了 9.1%（从 2923 例增加到 3189 例，=0.028）。这种增加与 EMS 未尝试复苏的 OHCA 年发生率增加 26.3%（从 993 例增加到 1253 例，=0.012）有关，而 EMS 尝试复苏的 OHCA 年发生率没有显著变化（从 1930 例增加到 1936 例，=0.416）。仅考虑复苏尝试的病例，出院时的生存率增加（从 7.3%增加到 9.5%，=0.02）。然而，当考虑所有 OHCA 时，生存率的提高并未达到统计学意义（从 4.8%增加到 5.7%，=0.17）。
结论
我们证明，与 EMS 未尝试复苏的 OHCA 数量增加相关的 OHCA 总数增加。这种 EMS 未尝试复苏的 OHCA 比例的增加，削弱了 EMS 治疗患者生存率提高的效果。
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