Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, United States.
Emory University, United States.
Resuscitation. 2022 Oct;179:88-93. doi: 10.1016/j.resuscitation.2022.08.003. Epub 2022 Aug 6.
Everyday, nearly 1000 U.S. adults experience out-of-hospital cardiac arrest (OHCA). Survival to hospital discharge varies across many factors, including sociodemographics, location of arrest, and whether bystander intervention was provided. The current study examines recent trends in OHCA survival by location of arrest using a cohort of emergency medical service (EMS) agencies that contributed data to the Cardiac Arrest Registry to Enhance Survival.
The 2015 CARES cohort (N = 122,613) includes EMS agencies contributing data across five consecutive years, 2015-2019. We assessed trends in EMS-attended OHCA survival for the 2015 CARES cohort by location of arrest - public, residential, nursing home. Unadjusted and adjusted percentages were estimated using 3-level hierarchical logistic regression models among cases aged 18-65 years.
Overall, survival from EMS-attended OHCA significantly increased from 12.5% in 2015 to 13.8% in 2019 (p = 0.001). Survival from bystander witnessed arrests also increased significantly from 17.8% in 2015 to 19.7% in 2019 (p = 0.004). The trend for survival increased overall and for bystander witnessed OHCAs occurring in public places and nursing homes.
Increasing trends for EMS-attended OHCA survival were observed in the overall and bystander witnessed groups. No change in the trend for survival was observed among OHCAs in the groups most likely to have a desirable outcome - bystander witnessed, with a shockable rhythm, and receiving bystander intervention. Reporting and monitoring of OHCA may be an important first step in improving outcomes. Additional community interventions focused on bystander CPR and AED use may be warranted.
每天，近 1000 名美国成年人经历院外心脏骤停（OHCA）。从出院到存活的生存率因多种因素而异，包括社会人口统计学、逮捕地点以及是否有旁观者干预。本研究使用向心脏骤停登记处增强生存（CARES）数据库提供数据的一组紧急医疗服务（EMS）机构，通过逮捕地点检查 OHCA 存活率的最新趋势。
2015 年 CARES 队列（N=122613）包括在 2015 年至 2019 年连续五年内提供数据的 EMS 机构。我们通过逮捕地点-公共场所、住宅、养老院，评估 2015 年 CARES 队列中 EMS 参与的 OHCA 生存率的趋势。在年龄为 18-65 岁的病例中，使用 3 级分层逻辑回归模型估计未调整和调整后的百分比。
总体而言，从 EMS 参与的 OHCA 中存活的比例从 2015 年的 12.5%显著增加到 2019 年的 13.8%（p=0.001）。从旁观者目击的逮捕中存活的比例也从 2015 年的 17.8%显著增加到 2019 年的 19.7%（p=0.004）。总体而言，以及在公共场所和养老院发生的旁观者目击 OHCA 中，存活率的趋势有所增加。
在总体和旁观者目击的群体中，观察到 EMS 参与的 OHCA 生存率的上升趋势。在旁观者目击、有可除颤节律和接受旁观者干预的最有可能产生理想结果的群体中，生存率趋势没有变化。OHCA 的报告和监测可能是改善结果的重要第一步。可能需要针对旁观者 CPR 和 AED 使用的额外社区干预措施。
