欧洲急救响应系统与院外心脏骤停后自主循环恢复及生存情况的差异：一项登记队列研究
European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts.
作者信息
Oving Iris, de Graaf Corina, Masterson Siobhan, Koster Rudolph W, Zwinderman Aeilko H, Stieglis Remy, AliHodzic Hajriz, Baldi Enrico, Betz Susanne, Cimpoesu Diana, Folke Fredrik, Rupp Dennis, Semeraro Federico, Truhlar Anatolij, Tan Hanno L, Blom Marieke T
机构信息
Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Department of General Practice, National University of Ireland Galway and National Ambulance Service, Dublin, Ireland.
出版信息
Lancet Reg Health Eur. 2020 Nov 20;1:100004. doi: 10.1016/j.lanepe.2020.100004. eCollection 2021 Feb.
BACKGROUND
In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe.
METHODS
Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated.
FINDINGS
We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%-25%]; <0.001; survival in total population [=15.859]: 13% [95%CI 12%-15%] vs. 5% [95%CI 4%-6%]; <0.001; survival in Utstein comparator group [=2326]: 33% [95%CI 30%-36%] vs. 18% [95%CI 16%-20%]; <0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all <0.050).
INTERPRETATION
European regions with dispatched FRs showed higher ROSC and survival-rates than regions without.
FUNDING
This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).
背景
在欧洲，院外心脏骤停（OHCA）后的生存率在不同地区差异很大。是否存在派遣急救人员（FRs；主要的FR类型：消防员、警察、市民急救员）的系统可能与生存率相关。本研究旨在评估欧洲地区拥有派遣FR系统与自主循环恢复（ROSC）率及生存率之间的关联。
方法
将欧洲OHCA派遣FR系统的清查结果与EuReCa-TWO研究的汇总ROSC和生存数据以及额外收集的数据相结合。进行回归分析（按每个地区纳入的患者数量加权），以研究拥有派遣FR系统与总人群以及初始心律可电击、目击OHCA和旁观者心肺复苏（CPR；Utstein比较组）患者的ROSC及出院生存率之间的关联。对于没有派遣FR系统的地区，估计如果存在派遣FR系统时的理论生存率。
研究结果
我们纳入了27个欧洲地区。总组中有15859例OHCA，Utstein比较组中有2326例OHCA。与没有FR系统的地区相比，有FR系统的地区汇总ROSC和生存率显著更高（ROSC：36%[95%CI 35%-37%]对24%[95%CI 23%-25%]；<0.001；总人群生存率[=15859]：13%[95%CI 12%-15%]对5%[95%CI 4%-6%]；<0.001；Utstein比较组生存率[=2326]：33%[95%CI 30%-36%]对18%[95%CI 16%-20%]；<0.001），并且与只有一种FR类型的地区相比，有多种FR类型的地区也是如此。所有主要的FR类型都与更高的生存率相关（均<0.050）。
解读
欧洲有派遣FR的地区比没有的地区显示出更高的ROSC和生存率。
资金支持
本项目/工作获得了欧盟“地平线2020”研究与创新计划的资助，项目缩写为ESCAPE-NET，资助协议编号为733381（IO、HLT和MTB），以及欧盟COST计划的资助，项目缩写为PARQ，资助协议编号为CA19137（IO、DC、HLT、MTB）。HLT和MTB得到了荷兰心血管研究倡议、荷兰心脏基金会、荷兰大学医学中心联合会、荷兰卫生研究与发展组织、荷兰皇家科学院的资助——CVON2017 - 15 RESCUED（HLT）以及CVON2018 - 30 Predict2（HLT和MTB）。
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