Baldi Enrico, Compagnoni Sara, Buratti Stefano, Primi Roberto, Bendotti Sara, Currao Alessia, Gentile Francesca Romana, Sechi Giuseppe Maria, Mare Claudio, Bertona Roberta, Raimondi Cominesi Irene, Taravelli Erika, Fava Cristian, Danzi Gian Battista, Oltrona Visconti Luigi, Savastano Simone
Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.
Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.
Front Cardiovasc Med. 2021 Dec 15;8:764043. doi: 10.3389/fcvm.2021.764043. eCollection 2021.
No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories. We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient. A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the "all-EMS treated" group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8-30.2), 6.8 (95%CI, 3.8-10.7), 3.8 (95%CI, 1.7-6.7), 4.05 (95%CI, 1.9-6.9), and 2.6 (95%CI, 1.03-4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories "shockable bystander witnessed" and "shockable bystander CPR": SMRs of 19.4 (95%CI, 11.3-29.8) and 19.4 (95%CI, 10.8-30.6) for the first year and of 6.8 (95%CI, 6.6-13) and 8.1 (95%CI, 3.1-15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1-2. The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.
目前尚无基于不同乌斯坦（Utstein）亚组的院外心脏骤停（OHCA）患者长期生存情况的数据，而这些亚组的生存情况预计会有显著差异。我们旨在对根据乌斯坦分类划分的OHCA患者进行首次长期生存分析。我们分析了2015年至2019年前瞻性纳入伦巴第心脏骤停登记处（Lombardia CARe）的所有4924例OHCA病例。对每位患者分析其院前数据、生存情况以及事件发生后1个月、6个月和12个月，然后每年直至5年的脑功能分类评分（CPC）。在所有乌斯坦分类的随访期间均观察到生存率下降。“所有接受急救医疗服务治疗”组的死亡风险在所有随访年份均超过一般人群，随访第一年至第五年的标准化死亡比（SMR）分别为23（95%CI，16.8 - 30.2）、6.8（95%CI，3.8 - 10.7）、3.8（95%CI，1.7 - 6.7）、4.05（95%CI，1.9 - 6.9）和2.6（95%CI，1.03 - 4.8）。“旁观者目击可除颤”和“旁观者心肺复苏可除颤”这两个乌斯坦分类的死亡风险也较高：第一年的SMR分别为19.4（95%CI，11.3 - 29.8）和19.4（95%CI，10.8 - 30.6），第二年分别为6.8（95%CI，6.6 - 13）和8.1（95%CI，3.1 - 15.3）。考虑出院时CPC为1 - 2的患者，观察到类似结果。从医院存活出院的OHCA患者的死亡率高于意大利标准人群，包括那些具有最有利OHCA特征的患者以及出院时神经功能良好的患者。下一次乌斯坦式修订应纳入长期随访。
