院外心脏骤停存活率在急救医疗服务机构间的差异。
Variation in Out-of-Hospital Cardiac Arrest Survival Across Emergency Medical Service Agencies.
机构信息
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (R.A.G., P.G.J., J.A.S., P.S.C.).
University of Iowa Carver College of Medicine (S.G.).
出版信息
Circ Cardiovasc Qual Outcomes. 2022 Jun;15(6):e008755. doi: 10.1161/CIRCOUTCOMES.121.008755. Epub 2022 Jun 14.
BACKGROUND
Although studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by geographic location, little is known about variation in OHCA survival at the level of emergency medical service (EMS) agencies-which may have modifiable practices, unlike counties and regions. We quantified the variation in OHCA survival across EMS agencies and explored whether variation in 2 specific EMS resuscitation practices were associated with survival to hospital admission.
METHODS
Within the Cardiac Arrest Registry to Enhance Survival, a prospective registry representing ≈51% of the US population, we identified 258 342 OHCAs from 764 EMS agencies with 10 OHCA cases annually during 2015 to 2019. Using hierarchical logistic regression, risk-standardized rates of survival to hospital admission were computed for each EMS agency. We quantified inter-agency variation in survival with median odds ratios and assessed the association of 2 resuscitation practices (EMS response time and the proportion of OHCAs with termination of resuscitation without meeting futility criteria) with EMS agency survival rates to hospital admission.
RESULTS
Across 764 EMS agencies comprising 258 342 OHCAs, the median risk-standardized rate of survival to hospital admission was 27.3% (interquartile range, 24.5%-30.1%; range: 16.0%-45.6%). The adjusted median odds ratio was 1.35 (95% CI, 1.32-1.39), denoting that the odds of survival of 2 patients with identical covariates varied by 35% at 2 randomly selected EMS agencies. EMS agencies in the lowest quartile of risk-standardized survival had longer EMS response times when compared with the highest quartile (12.0±3.4 versus 9.0±2.6 minutes; <0.001), and a higher proportion of OHCAs with termination of resuscitation without meeting futility criteria (27.9±16.1% versus 18.9±11.4%; <0.001).
CONCLUSIONS
Survival after OHCA varies widely across EMS agencies. EMS response times and termination of resuscitation practices were associated with agency-level rates of survival to hospital admission, suggesting potentially modifiable practices which can improve OHCA survival.
背景
尽管已有研究报告了地理位置对院外心脏骤停（OHCA）存活率的影响，但对于急救医疗服务（EMS）机构之间 OHCA 存活率的差异却知之甚少，而 EMS 机构的差异可能存在可改变的实践，与县和地区不同。我们量化了 EMS 机构之间 OHCA 存活率的差异，并探讨了两种特定的 EMS 复苏实践的差异是否与入院存活率相关。
方法
在心脏骤停登记以提高生存率中，这是一个代表约 51%的美国人口的前瞻性登记，我们从 2015 年至 2019 年期间的 764 个 EMS 机构中确定了 258342 例 OHCA，每年有 10 例 OHCA。使用分层逻辑回归，为每个 EMS 机构计算了到达医院的存活率的风险标准化率。我们使用中位数优势比量化了机构间存活率的差异，并评估了两种复苏实践（EMS 反应时间和未达到无效标准而终止复苏的 OHCA 比例）与 EMS 机构到达医院的存活率的关系。
结果
在由 258342 例 OHCA 组成的 764 个 EMS 机构中，到达医院的风险标准化存活率的中位数为 27.3%（四分位距，24.5%-30.1%；范围：16.0%-45.6%）。调整后的中位数优势比为 1.35（95%CI，1.32-1.39），这意味着在 2 个随机选择的 EMS 机构中，2 名具有相同协变量的患者的生存机会差异为 35%。与最高四分位组相比，风险标准化生存率最低四分位组的 EMS 反应时间更长（12.0±3.4 与 9.0±2.6 分钟；<0.001），且未达到无效标准而终止复苏的 OHCA 比例更高（27.9±16.1%与 18.9±11.4%；<0.001）。
结论
OHCA 后生存率在 EMS 机构之间差异很大。EMS 反应时间和复苏实践的终止与机构层面到达医院的存活率相关，这表明可能存在可改变的实践，可以提高 OHCA 的生存率。
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