Yoon Hanna, Ahn Ki Ok, Park Jeong Ho, Lee Sun Young
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
Resuscitation. 2022 Jan;170:107-114. doi: 10.1016/j.resuscitation.2021.11.012. Epub 2021 Nov 22.
We aimed to investigate the interaction effects between transfer to a heart attack centre [HAC] and prehospital re-arrest on the clinical outcomes of patients with out-of-hospital cardiac arrest [OHCA].
We included adult patients with OHCA of presumed cardiac aetiology from January 2012 to December 2018. The main exposure variable was prehospital re-arrest, defined as recurrence of cardiac arrest with a loss of palpable pulse upon hospital arrival. The other exposure variable was the resuscitation capacity of the receiving hospital [HAC or Non-HAC]. The outcome variable was neurological recovery. A multivariable logistic regression was performed to determine the interaction effects.
The final analysis included 6935 patients. Of these, 21.9% (n = 1521) experienced prehospital re-arrest, whereas 41.3% (n = 2866) were transferred to a non-HAC. The prehospital re-arrest group associated with poor neurological recovery (adjusted odds ratio [AOR], 0.25; 95% confidence interval [CI], 0.21-0.29;). Transfer to an HAC had beneficial effects on neurological recovery (AOR, 3.40 [95% CI, 3.04-3.85]. In the interaction model, wherein prehospital re-arrest patients who were transferred to a non-HAC were used as reference, the AOR of prehospital re-arrest patients who were transferred to an HAC, non-re-arrest patients who were transferred to a non-HAC, and non-re-arrest patients who were transferred to a non-HAC was 2.41 (95% CI, 1.73-3.35), 3.09 (95% CI, 2.33-4.10), and 11.07 (95% CI, 8.40-14.59) respectively (interaction p = 0.001).
Transport to a heart attack centre was beneficial to the clinical outcomes of patients who achieved prehospital ROSC after OHCA. The magnitude of that benefit was significantly modified by whether prehospital re-arrest had occurred.
我们旨在研究转至心脏病发作中心[HAC]与院前再次心脏骤停对院外心脏骤停[OHCA]患者临床结局的交互作用。
我们纳入了2012年1月至2018年12月间病因推测为心脏原因的成年OHCA患者。主要暴露变量为院前再次心脏骤停，定义为入院时心脏骤停复发且无法触及脉搏。另一个暴露变量为接收医院（HAC或非HAC）的复苏能力。结局变量为神经功能恢复。进行多变量逻辑回归以确定交互作用。
最终分析纳入6935例患者。其中，21.9%（n = 1521）经历了院前再次心脏骤停，而41.3%（n = 2866）被转至非HAC。院前再次心脏骤停组与神经功能恢复不良相关（调整优势比[AOR]，0.25；95%置信区间[CI]，0.21 - 0.29）。转至HAC对神经功能恢复有有益影响（AOR，3.40[95%CI，3.04 - 3.85]）。在交互模型中，以转至非HAC的院前再次心脏骤停患者作为对照，转至HAC的院前再次心脏骤停患者、转至非HAC的非再次心脏骤停患者以及转至HAC的非再次心脏骤停患者的AOR分别为2.41（95%CI，1.73 - 3.35）、3.09（95%CI，2.33 - 4.10）和11.07（9-5%CI，8.40 - 14.
