Su Yi-Chia, Ng Chip-Jin, Chien Liang-Tien, Tsai Li-Heng, Chien Cheng-Yu, Hsu Shou-Chien
Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan.
Int J Gen Med. 2024 May 18;17:2241-2249. doi: 10.2147/IJGM.S464936. eCollection 2024.
Various factors, such as event location and response time, influence the outcomes of out-of-hospital cardiac arrest (OHCA). Very few studies have explored the delivery of basic life support (BLS) to patients having OHCA at health clinics or nursing homes-settings with professional BLS providers. Thus, in this study, we compared prognostic and survival outcomes between health clinics, nursing homes, and other public places (eg, workplaces and sports facilities/recreational areas) to offer insights for optimizing OHCA outcomes.
This study included adults who had nontraumatic OHCA in Taoyuan City between January 2017 and December 2022.
We collected data on patient characteristics, emergency medical service parameters, onsite patient management, automated external defibrillator (AED) locations, OHCA prognosis, and survival outcomes. Multivariate analyses were performed to predict survival to discharge (primary outcome) and neurological outcomes at discharge (secondary outcome).
During the study period, the numbers of OHCA events at health clinics, nursing homes, and other public places were 158, 208, and 1986, respectively. The mean age of OHCA in health medical clinics, nursing home and other public places were 63.4, 81.5 and 64.7, respectively (P value<0.001). The proportion of witnessed events, rate of bystander resuscitation, and frequency of AED utilization were the highest for health clinics (53.2% (84/158), 83.4% (132/158), and 13.3% (21/158), respectively, P value<0.001). The average AED-scene distances and response times were the lowest for health clinics (388.8 m and 5.4 min, respectively). In initial shockable rhythm group, the probabilities of survival to discharge at discharge were the highest for health clinics (aOR=1.41, 95% CI=1.04-1.81, P value=0.041)) and lowest for nursing homes (aOR=0.84, 95% CI=0.76-0.93, P value=0.024).
Our research shows that OHCA patients at medical health clinics have higher rates of witnessing and bystander CPR and AED usage than other public places. However, while survival rates for patients with shockable rhythms are slightly better at health clinics, the neurological outcomes are not significantly different. The AED-scene distances are too far to be used effectively.
多种因素，如事件发生地点和响应时间，会影响院外心脏骤停（OHCA）的结果。很少有研究探讨在配备专业基础生命支持（BLS）人员的健康诊所或养老院环境中，对发生OHCA的患者进行BLS的情况。因此，在本研究中，我们比较了健康诊所、养老院和其他公共场所（如工作场所和体育设施/娱乐区域）的预后和生存结果，以提供优化OHCA结果的见解。
本研究纳入了2017年1月至2022年12月在桃园市发生非创伤性OHCA的成年人。
我们收集了患者特征、紧急医疗服务参数、现场患者管理、自动体外除颤器（AED）位置、OHCA预后和生存结果的数据。进行多变量分析以预测出院生存率（主要结局）和出院时的神经学结局（次要结局）。
在研究期间，健康诊所、养老院和其他公共场所的OHCA事件数量分别为158例、208例和1986例。健康医疗诊所、养老院和其他公共场所OHCA患者的平均年龄分别为63.4岁、81.5岁和64.7岁（P值<0.001）。健康诊所目睹事件的比例、旁观者心肺复苏率和AED使用频率最高（分别为53.2%（84/158）、83.4%（132/158）和13.3%（21/158），P值<0.001）。健康诊所的平均AED-现场距离和响应时间最短（分别为388.8米和5.4分钟）。在初始可电击心律组中，健康诊所出院时的出院生存率最高（调整后比值比[aOR]=1.41，95%置信区间[CI]=1.04-1.81，P值=0.041），养老院最低（aOR=0.84，95%CI=0.76-0.93，P值=0.024）。
我们的研究表明，健康医疗诊所中的OHCA患者目睹事件、旁观者心肺复苏和AED使用的发生率高于其他公共场所。然而，虽然健康诊所中可电击心律患者的生存率略高，但神经学结局并无显著差异。AED-现场距离太远，无法有效使用。
