Department of Emergency Medicine, The University of Hong Kong, Hong Kong SAR, China.
Hong Kong Med J. 2023 Apr;29(2):142-149. doi: 10.12809/hkmj209140. Epub 2023 Mar 29.
Most out-of-hospital cardiac arrests in Hong Kong involve older adults. The likelihood of survival varies among locations. This study investigated patient and bystander characteristics, as well as the timing of interventions, that affect the prevalences of shockable rhythm and survival outcomes among cardiac arrests involving older adults in homes, on streets, and in other public places.
This secondary analysis of a territory-wide historical cohort used data collected by the Fire Services Department of Hong Kong from 1 August 2012 to 31 July 2013.
Bystander cardiopulmonary resuscitation was primarily performed by relatives in homes but not in non-residential locations. The intervals in terms of receipt of emergency medical services (EMS) call, initiation of bystander cardiopulmonary resuscitation, and receipt of defibrillation were longer for cardiac arrests that occurred in homes. The median interval for EMS to reach patients was 3 minutes longer in homes than on streets (P<0.001). Forty-seven percent of patients who developed cardiac arrest on streets had a shockable rhythm within the first 5 minutes after receipt of EMS call. Defibrillation within 15 minutes after receipt of EMS call was an independent predictor of 30-day survival (odds ratio=4.07; P=0.02). Fifty percent of patients who received defibrillation within 5 minutes in non-residential locations survived.
There were significant location-related differences in patient and bystander characteristics, interventions, and outcomes among cardiac arrests involving older adults. A large proportion of patients had a shockable rhythm in the early period after cardiac arrest. Good survival outcomes in out-of-hospital cardiac arrests involving older adults can be achieved through early bystander defibrillation and intervention.
在香港，大多数院外心脏骤停都涉及老年人。不同地点的存活率有所不同。本研究调查了影响涉及老年人的家中、街道和其他公共场所心脏骤停的可电击节律和生存结果的患者和旁观者特征以及干预时间。
这是对香港消防处 2012 年 8 月 1 日至 2013 年 7 月 31 日期间收集的数据进行的一项全港范围的历史队列的二次分析。
家中的旁观者心肺复苏主要由亲属进行，但非居住场所则不然。接受紧急医疗服务（EMS）呼叫、开始旁观者心肺复苏和接受除颤的时间间隔在家庭中发生的心脏骤停中更长。家中 EMS 到达患者的中位数间隔比街道长 3 分钟（P<0.001）。在街上发生心脏骤停的患者中，有 47%在接到 EMS 电话后的前 5 分钟内出现可电击节律。在接到 EMS 电话后 15 分钟内除颤是 30 天生存的独立预测因素（优势比=4.07；P=0.02）。在非居住场所内 5 分钟内接受除颤的患者中有 50%存活。
涉及老年人的心脏骤停患者和旁观者特征、干预措施和结果存在显著的位置相关差异。很大一部分患者在心脏骤停后早期出现可电击节律。通过早期旁观者除颤和干预，可以实现涉及老年人的院外心脏骤停的良好生存结果。
