Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.
PLoS One. 2021 Sep 28;16(9):e0257883. doi: 10.1371/journal.pone.0257883. eCollection 2021.
This study aimed to assess the prognostic value of the changes in cardiac arrest rhythms from the prehospital stage to the ED (emergency department) in out-of-hospital cardiac arrest (OHCA) patients without prehospital returns of spontaneous circulation (ROSC).
This retrospective analysis was performed using nationwide population-based OHCA data from South Korea between 2012 and 2016. Patients with OHCA with medical causes and without prehospital ROSC were included and divided into four groups according to the nature of their cardiac arrest rhythms (shockable or non-shockable) in the prehospital stage and in the ED: (1) the shockable and shockable (Shock-Shock) group, (2) the shockable and non-shockable (Shock-NShock) group, (3) the non-shockable and shockable (NShock-Shock) group, and (4) the non-shockable and non-shockable (NShock-NShock) group. The presence of a shockable rhythm was confirmed based on the delivery of an electrical shock. Propensity score matching and multivariate logistic regression analyses were used to assess the effect of changes in the cardiac rhythms on patient outcomes. The primary outcome was sustained ROSC in the ED; the secondary outcomes were survival to hospital discharge and good neurological outcomes at hospital discharge.
After applying the exclusion criteria, 51,060 eligible patients were included in the study (Shock-Shock, 4223; Shock-NShock, 3060; NShock-Shock, 11,509; NShock-NShock, 32,268). The propensity score-matched data were extracted from the six comparative subgroups. For sustained ROSC in the ED, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01) and NShock-NShock (P <0.01), Shock-NShock showed a lower likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), NShock-Shock showed a higher likelihood NShock-NShock (P <0.01). For survival to hospital discharge, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed a higher likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), of sustained ROSC in the ED. For good neurological outcomes, Shock-Shock showed higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed better likelihood than NShock-NShock (P <0.01), NShock-Shock showed a better likelihood than NShock-NShock (P <0.01).
Sustained ROSC in the ED may be expected for patients with shockable rhythms in the ED compared with those with non-shockable rhythms in the ED. For the clinical outcomes, survival to hospital discharge and neurological outcomes, patients with Shock-Shock showed the best outcome, whereas patients with NShock-NShock showed the poorest outcome and Shock-NShock showed a higher likelihood of achieving survival to hospital discharge with no significant differences in the neurological outcomes compared with NShock-Shock.
本研究旨在评估在无院前自主循环恢复（ROSC）的院外心脏骤停（OHCA）患者中，从院前阶段到急诊室（ED）心脏骤停节律变化的预后价值。
本回顾性分析使用了韩国 2012 年至 2016 年期间全国范围内基于人群的 OHCA 数据。纳入了由医疗原因引起的 OHCA 患者，且无院前 ROSC，并根据其在院前阶段和 ED 中的心脏骤停节律（可电击或不可电击）分为四组：（1）可电击和可电击（Shock-Shock）组，（2）可电击和不可电击（Shock-NShock）组，（3）不可电击和可电击（NShock-Shock）组，和（4）不可电击和不可电击（NShock-NShock）组。存在可电击节律的患者通过电击确认。使用倾向评分匹配和多变量逻辑回归分析评估心脏节律变化对患者结局的影响。主要结局是 ED 中持续 ROSC；次要结局是出院时存活和出院时良好的神经功能结局。
在应用排除标准后，共有 51060 名符合条件的患者纳入研究（Shock-Shock 组 4223 例，Shock-NShock 组 3060 例，NShock-Shock 组 11509 例，NShock-NShock 组 32268 例）。从六个比较亚组中提取了倾向评分匹配的数据。对于 ED 中持续 ROSC，Shock-Shock 组的可能性高于 Shock-NShock 组（P<0.01）和 NShock-NShock 组（P<0.01），Shock-NShock 组的可能性低于 NShock-Shock 组（P<0.01）和 NShock-NShock 组（P<0.01），NShock-Shock 组的可能性高于 NShock-NShock 组（P<0.01）。对于出院时存活，Shock-Shock 组的可能性高于 Shock-NShock 组（P<0.01）、NShock-Shock 组（P<0.01）和 NShock-NShock 组（P<0.01），Shock-NShock 组的可能性高于 NShock-Shock 组（P<0.01）和 NShock-NShock 组（P<0.01），对于良好的神经功能结局，Shock-Shock 组的可能性高于 Shock-NShock 组（P<0.01）、NShock-Shock 组（P<0.01）和 NShock-NShock 组（P<0.01），Shock-NShock 组的可能性高于 NShock-NShock 组（P<0.01），NShock-Shock 组的可能性高于 NShock-NShock 组（P<0.01）。
与 ED 中的不可电击节律相比，ED 中具有可电击节律的患者可能会出现 ED 中持续 ROSC。对于临床结局，即出院时存活和神经结局，Shock-Shock 组患者的结局最好，而 NShock-NShock 组患者的结局最差，Shock-NShock 组与 NShock-Shock 组相比，出院时存活的可能性更高，但神经结局无显著差异。
