救护站病例数量与院外心脏骤停临床结局之间的关联：一项全国性多层次分析。

Association between case volume of ambulance stations and clinical outcomes of out-of-hospital cardiac arrest: A nationwide multilevel analysis.

作者信息

Kim Ki Hong, Ro Young Sun, Park Jeong Ho, Kim Tae Han, Jeong Joo, Hong Ki Jeong, Song Kyoung Jun, Shin Sang Do

机构信息

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.

Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.

出版信息

Resuscitation. 2021 Apr 23;163:71-77. doi: 10.1016/j.resuscitation.2021.04.014.

DOI:10.1016/j.resuscitation.2021.04.014

PMID:33895233

Abstract

OBJECTIVES

The case volume effects of ambulance stations on the survival of out-of-hospital cardiac arrest (OHCA) patients are uncertain. This study was conducted to evaluate the association between the case volume of ambulance stations and clinical outcomes in OHCAs by the number of emergency medical services (EMS) providers at the scene.

METHODS

Adult cardiac EMS-treated OHCAs between 2015 and 2018 were enrolled. The main exposure was the annual OHCA case volumes of 204 ambulance stations in Korea, which were categorized into three groups; low-volume (<100), moderate-volume (100-159) and high-volume (≥160). The primary and secondary outcomes were good neurological recovery and survival to discharge. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs). Interaction analysis between the number of EMS providers at the scene and the exposure variable was performed.

RESULTS

A total of 92,534 patients were enrolled. OHCAs in the low-volume group tended to be arrest in a public place or a non-metropolitan area, less prehospital administration of an advanced airway and intravenous management. Significant differences were found the main analysis: AORs (95% CIs) compared to the low-volume group were 1.15 (1.03-1.29) and 1.14 (1.03-1.27) in the high-volume and moderate-volume groups for good neurological recovery and 1.19 (1.07-1.33) and 1.14 (1.04-1.25) in the high-volume and moderate-volume groups for survival to discharge. Significant interaction effects between the number of EMS providers at the scene and case volume on clinical outcomes were found.

CONCLUSION

OHCA case volumes of ambulance stations are associated with clinical outcomes after cardiac arrest.

摘要

目的

救护站的病例数量对院外心脏骤停（OHCA）患者生存率的影响尚不确定。本研究旨在通过现场急救医疗服务（EMS）人员数量，评估救护站病例数量与OHCA临床结局之间的关联。

方法

纳入2015年至2018年间接受成人心脏EMS治疗的OHCA患者。主要暴露因素是韩国204个救护站的年度OHCA病例数量，分为三组：低病例量组（<100）、中等病例量组（100 - 159）和高病例量组（≥160）。主要结局和次要结局分别是良好的神经功能恢复和出院生存。进行多水平多变量逻辑回归分析以计算调整后的比值比（AOR）。对现场EMS人员数量与暴露变量之间进行交互分析。

结果

共纳入92,534例患者。低病例量组的OHCA患者往往在公共场所或非大都市地区发生心脏骤停，院前高级气道管理和静脉给药较少。在主要分析中发现显著差异：与低病例量组相比，高病例量组和中等病例量组在良好神经功能恢复方面的AOR（95%可信区间）分别为1.15（1.03 - 1.29）和1.14（1.03 - 1.27），在出院生存方面分别为1.19（1.07 - 1.33）和1.14（1.04 - 1.25）。发现现场EMS人员数量与病例量对临床结局有显著的交互作用。