Park Gihun, Ahn Chiwon, Kim Jae Hwan
Department of Emergency Medicine, Chung-Ang University, Seoul, Republic of Korea.
Department of Emergency Medicine, Chung-Ang University, Seoul, Republic of Korea
BMJ Open. 2022 Apr 26;12(4):e060378. doi: 10.1136/bmjopen-2021-060378.
To evaluate the characteristics of poisoning-induced out-of-hospital cardiac arrest (pOHCA) and the factors influencing survival to discharge and good neurological outcomes using a nationwide, population-based database.
Nationwide, retrospective, population-based cohort study.
This study included adult patients who had experienced pOHCA and those who had not (non-pOHCA patients) in South Korea from January 2008 to December 2018.
The primary outcome was survival to discharge, and the secondary outcome was a good neurological outcome.
The basic characteristics of pOHCA and non-pOHCA patients were analysed by descriptive analysis. Logistic regression analysis was conducted for related variables, including pOHCA.
A total of 173 190 patients were included, and 3582 patients (2.1%) were in the pOHCA group. Some of the pOHCA patients were young (58.2±17.8 vs 69.0±15.5, p<0.001), a few of their cardiac arrests were witnessed (12.8% vs 45.1%, p<0.001), a few were resuscitated by bystanders (8.2% vs 14.8%, p<0.001) and they had low shockable rhythm rates (1.2% vs 8.8%, p<0.001). They showed significantly lower survival to discharge and poorer neurological outcomes than non-pOHCA patients (survival to discharge, 3.7% vs 6.2%, p<0.001; good neurological outcomes, 1.3% vs 3.2%, p<0.001). There were no significant differences between pOHCA and non-pOHCA patients in terms of the adjusted ORs for survival to discharge (adjusted OR 0.608; 95% CI 0.86 to 1.27) and good neurological outcomes (adjusted OR 1.03; 95% CI 0.73 to 1.42).
This study shows that apparent aetiology of OHCA caused by poison, did not influence survival to discharge and good neurological outcomes. Furthermore, pOHCA occurs in younger patients and has fewer witnesses and shockable rhythms. pOHCA did not influence survival to discharge and good neurological outcomes. Also, pesticides and gases were the most frequent substances causing pOHCA in South Korea.
利用全国性的基于人群的数据库评估中毒导致的院外心脏骤停（pOHCA）的特征以及影响出院存活和良好神经功能转归的因素。
全国性、回顾性、基于人群的队列研究。
本研究纳入了2008年1月至2018年12月期间在韩国经历过pOHCA的成年患者以及未经历过的患者（非pOHCA患者）。
主要结局是出院存活，次要结局是良好的神经功能转归。
通过描述性分析对pOHCA和非pOHCA患者的基本特征进行分析。对包括pOHCA在内的相关变量进行逻辑回归分析。
共纳入173190例患者，3582例患者（2.1%）在pOHCA组。部分pOHCA患者较为年轻（58.2±17.8岁 vs 69.0±15.5岁，p<0.001），少数患者的心脏骤停有目击者（12.8% vs 45.1%，p<0.001），少数患者由旁观者进行了心肺复苏（8.2% vs 14.8%，p<0.001），且他们的可电击心律发生率较低（1.2% vs 8.8%，p<0.001）。与非pOHCA患者相比，他们的出院存活率显著更低，神经功能转归更差（出院存活，3.7% vs 6.2%，p<0.001；良好神经功能转归，1.3% vs 3.2%，p<0.001）。在出院存活的调整比值比（调整比值比0.608；95%置信区间0.86至1.27）和良好神经功能转归方面，pOHCA与非pOHCA患者之间无显著差异（调整比值比1.03；95%置信区间0.73至1.42）。
本研究表明，中毒导致的院外心脏骤停的明显病因不影响出院存活和良好神经功能转归。此外，pOHCA发生在较年轻的患者中，目击者和可电击心律较少。pOHCA不影响出院存活和良好神经功能转归。而且，在韩国，农药和气体是导致pOHCA最常见的物质。
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