Miyako Joji, Nakagawa Koshi, Sagisaka Ryo, Tanaka Shota, Takeuchi Hidekazu, Takyu Hiroshi, Tanaka Hideharu
Research Institute of Disaster Management and EMS, Kokushikan University, Tokyo, Japan.
Department of Emergency Medical System, Graduate School, Kokushikan University, Tokyo, Japan.
Resusc Plus. 2023 Aug 9;15:100438. doi: 10.1016/j.resplu.2023.100438. eCollection 2023 Sep.
The purpose of this study was to stratify patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with bystander procedures pre-emergency medical service (EMS) arrival and those who achieved ROSC with procedures post-EMS arrival, compare outcomes at 1-month, and identify factors associated with pre-EMS-arrival-ROSC.
A retrospective cohort analysis of OHCAs occurring at stations in the Tokyo metropolitan area between 2014 and 2018 was conducted. Subjects were stratified by ROSC phase (categorized as pre- and post-EMS arrival and non-ROSC). Survival at 1-month post-OHCA and the percentage of favourable neurological function in each ROSC phase were analysed. In addition, factors associated with Pre-EMS-arrival-ROSC were identified using multivariable logistic regression analysis. The time of occurrence of OHCA was classified into four-time categories as follows. Rush hour on morning [7:00-9:00], Rush hour on evening [17:00-21:00], Daytime [9:00-17:00], and Night or Early morning [21:00-7:00].
Among the 63,089 OHCA in the dataset, 702 were analysed. At 1-month after OHCA occurrence, Pre-EMS-arrival ROSC had higher survival rates than post-EMS-arrival ROSC (86.8% vs. 54.1%) and CPC1-2 rates (73.6% vs. 38.5%). Pre-EMS-arrival ROSC was associated (adjusted odds ratio [95% confidence interval]) with non-older-adult patients (1.59 [1.05-2.43]), witnessed OHCA (1.82 [1.03-3.31]), evening rush-hour (17:00-21:00; 2.08 [1.05-4.11]), conventional CPR (33.42 [7.82-868.44]), hands-only CPR (17.06 [4.30-436.48]), bystander defibrillation performed once (3.31 [1.59-6.99]).
In an OHCA at a station in Tokyo, ROSC achieved with bystander treatment alone had a better outcome at 1-month compared to ROSC with EMS intervention.
本研究旨在对在院外心脏骤停（OHCA）时，在紧急医疗服务（EMS）到达前通过旁观者实施急救程序实现自主循环恢复（ROSC）的患者，与在EMS到达后通过相关程序实现ROSC的患者进行分层，比较1个月时的结局，并确定与EMS到达前ROSC相关的因素。
对2014年至2018年东京都市区各站点发生的OHCA进行回顾性队列分析。根据ROSC阶段（分为EMS到达前和到达后以及未实现ROSC）对研究对象进行分层。分析OHCA发生后1个月的生存率以及各ROSC阶段神经功能良好的百分比。此外，使用多变量逻辑回归分析确定与EMS到达前ROSC相关的因素。OHCA的发生时间分为以下四个时间段：上午高峰时段[7:00 - 9:00]、晚上高峰时段[17:00 - 21:00]、白天[9:00 - 17:00]、夜间或凌晨[21:00 - 7:00]。
数据集中的63,089例OHCA中，702例被分析。在OHCA发生后1个月时，EMS到达前ROSC的生存率高于EMS到达后ROSC（86.8%对54.1%）以及脑功能分类（CPC）1 - 2级的比例（73.6%对38.5%）。EMS到达前ROSC与非老年患者（调整后的优势比[95%置信区间]为1.59[1.05 - 2.43]）、目睹的OHCA（1.82[1.03 - 3.31]）、晚上高峰时段（17:00 - 21:00；2.08[1.05 - 4.11]）、传统心肺复苏（33.42[7.82 - 868.44]）、单纯胸外按压心肺复苏（17.06[4.30 - 436.48]）、旁观者进行一次除颤（3.31[1.59 - 6.99]）相关。
在东京某站点发生的OHCA中，与EMS干预后实现ROSC相比，仅通过旁观者治疗实现ROSC在1个月时结局更好。
