Burns Timothy A, Touzeau Christopher, Kaufman Benjamin T, Butsch Alan L, Vesselinov Roumen, Stone Roger M
Montgomery County (MD) Fire and Rescue Service, Gaithersburg, MD, United States of America.
Am J Emerg Med. 2022 Jan;51:64-68. doi: 10.1016/j.ajem.2021.09.083. Epub 2021 Oct 12.
A decline in OHCA performance metrics during the pandemic has been reported in the literature but the cause is still not known. The Montgomery County Fire and Rescue Service (MCFRS) observed a decline in both the rate of return of spontaneous circulation (ROSC) and the proportion of resuscitations that resulted in cerebral performance category (CPC) 1 or 2 discharge of the patient beginning in March of 2020. This study examines whether the decline in these performance metrics persists when known COVID positive patients are excluded from the analysis.
Two samples of OHCA patients for similar time periods (one year apart) before and after the start of the COVID pandemic were developed. A database of known COVID positive patients among EMS encounters was used to identify and exclude COVID positive patients. OHCA outcomes in these two groups were then compared using a Chi-square test and Fisher's exact test for difference in proportions and Analysis of Variance (ANOVA) for difference in means. A two-stage multivariable logistic regression model was used to develop odds ratios for achieving ROSC and CPC 1 or 2 discharge in each period.
After excluding known COVID patients, 32.5% of the patients in the pre-COVID period achieved ROSC compared to 25.1% in the COVID period (p = 0.007). 6% of patients in the pre-COVID period were discharged with CPC 1 or 2 compared to 3.2% from the COVID era (p = 0.026). Controlling for all available patient characteristics, patients undergoing OHCA resuscitation prior to be beginning of the pandemic were 1.2 times more likely to achieve ROSC and 1.6 times more likely to be discharged with CPC 1 or 2 than non-COVID patients in the pandemic era sample.
When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought.
文献报道了大流行期间院外心脏骤停（OHCA）性能指标有所下降，但其原因仍不明。蒙哥马利县消防与救援服务局（MCFRS）观察到，自2020年3月起，自主循环恢复（ROSC）率以及复苏后患者脑功能分类（CPC）为1或2级出院的比例均有所下降。本研究旨在探讨在分析中排除已知的新冠阳性患者后，这些性能指标的下降情况是否仍然存在。
选取新冠大流行开始前后相似时间段（相隔一年）的两组OHCA患者样本。利用急救医疗服务（EMS）接触中已知的新冠阳性患者数据库来识别并排除新冠阳性患者。然后使用卡方检验和Fisher精确检验比较两组的比例差异，使用方差分析（ANOVA）比较两组的均值差异。采用两阶段多变量逻辑回归模型来计算每个时期实现ROSC以及CPC为1或2级出院的比值比。
排除已知的新冠患者后，新冠疫情前时期32.5%的患者实现了ROSC，而新冠疫情期间这一比例为25.1%（p = 0.007）。新冠疫情前时期6%的患者以CPC 1或2级出院，而新冠时期这一比例为3.2%（p = 0.026）。在控制所有可用的患者特征后，与疫情期间样本中的非新冠患者相比，疫情开始前接受OHCA复苏的患者实现ROSC的可能性高1.2倍，以CPC 1或2级出院的可能性高1.6倍。
排除已知的新冠患者后，疫情前接受OHCA复苏的患者更有可能实现ROSC以及CPC 1或2级出院。在大流行期间所有OHCA复苏中已知新冠阳性患者的比例不足以完全解释ROSC以及CPC 1或2级出院率的显著下降。必须寻找其他致病因素。
