School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
Department of Paramedicine, Victoria University, Melbourne, Victoria, Australia.
Heart. 2023 Aug 24;109(18):1363-1371. doi: 10.1136/heartjnl-2021-320559.
To assess the long-term functional and health-related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by initial defibrillation provider.
This retrospective study included adult non-traumatic OHCA with initial shockable rhythms between 2010 and 2019. Survivors at 12 months after arrest were invited to participate in structured telephone interviews. Outcomes were identified using the Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5 Dimension (EQ-5D), 12-Item Short Form Health Survey and living and work status-related questions.
6050 patients had initial shockable rhythms, 3211 (53.1%) had a pulse on hospital arrival, while 1879 (31.1%) were discharged alive. Bystander defibrillation using the closest automated external defibrillator had the highest survival rate (52.8%), followed by dispatched first responders (36.7%) and paramedics (27.9%). 1802 (29.8%) patients survived to 12-month postarrest; of these 1520 (84.4%) were interviewed. 1088 (71.6%) were initially shocked by paramedics, 271 (17.8%) by first responders and 161 (10.6%) by bystanders. Bystander-shocked survivors reported higher rates of living at home without care (87.5%, 75.2%, 77.0%, p<0.001), upper good recovery (GOS-E=8) (41.7%, 30.4%, 30.6%, p=0.002) and EQ-5D visual analogue scale (VAS) ≥80 (64.9%, 55.9%, 52.9%, p=0.003) compared with first responder and paramedics, respectively. After adjustment, initial bystander defibrillation was associated with higher odds of EQ-5D VAS ≥80 (adjusted OR (AOR) 1.56, 95% CI 1.15-2.10; p=0.004), good functional recovery (GOS-E ≥7) (AOR 1.53, 95% CI 1.12-2.11; p=0.009), living at home without care (AOR 1.77, 95% CI 1.16-2.71; p=0.009) and returning to work (AOR 1.72, 95% CI 1.05-2.81; p=0.031) compared with paramedic defibrillation.
Survivors receiving initial bystander defibrillation reported better functional and HRQoL outcomes at 12 months after arrest compared with those initially defibrillated by paramedics.
根据初始除颤提供者对院外心脏骤停（OHCA）幸存者进行分层，评估长期功能和健康相关生活质量（HRQoL）结局。
本回顾性研究纳入了 2010 年至 2019 年期间发生的非创伤性 OHCA 伴初始可电击节律的成年患者。在发病 12 个月后，邀请幸存者参加结构化电话访谈。使用格拉斯哥结局量表-扩展版（GOS-E）、欧洲五维健康量表（EQ-5D）、12 项简明健康调查和与生活及工作状况相关的问题来确定结局。
6050 例患者存在初始可电击节律，3211 例（53.1%）在入院时存在脉搏，1879 例（31.1%）存活出院。使用最近的自动体外除颤器进行旁观者除颤的存活率最高（52.8%），其次是调度的第一反应者（36.7%）和急救人员（27.9%）。1802 例（29.8%）患者在发病后 12 个月存活；其中 1520 例（84.4%）接受了采访。1088 例（71.6%）最初由急救人员除颤，271 例（17.8%）由第一反应者，161 例（10.6%）由旁观者。旁观者除颤的幸存者报告了更高的居家生活自理率（87.5%、75.2%、77.0%，p<0.001）、更高比例的良好恢复（GOS-E=8）（41.7%、30.4%、30.6%，p=0.002）和更高比例的 EQ-5D 视觉模拟量表（VAS）≥80（64.9%、55.9%、52.9%，p=0.003），与第一反应者和急救人员相比。调整后，初始旁观者除颤与更高的 EQ-5D VAS≥80 评分（调整后的比值比（AOR）1.56，95%置信区间 1.15-2.10；p=0.004）、良好的功能恢复（GOS-E≥7）（AOR 1.53，95%置信区间 1.12-2.11；p=0.009）、居家生活自理（AOR 1.77，95%置信区间 1.16-2.71；p=0.009）和重返工作岗位（AOR 1.72，95%置信区间 1.05-2.81；p=0.031）相关，与急救人员除颤相比。
与最初由急救人员除颤的幸存者相比，接受初始旁观者除颤的幸存者在发病后 12 个月报告了更好的功能和 HRQoL 结局。
