Faculty of Emergency Medical Science, School of Health Science and Medical Care, Meiji University of Integrative Medicine, Kyoto, Japan; Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan; Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Tokyo, Japan.
Am J Emerg Med. 2024 Aug;82:94-100. doi: 10.1016/j.ajem.2024.05.021. Epub 2024 May 24.
In cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis.
This retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as "on the scene" or "in the ambulance." Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month.
ETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57-2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47-2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33-2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89-2.40).
Our analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.
在院外心脏骤停（OHCA）发生在家中的情况下，日本急救医疗服务人员根据自己的判断决定是在现场还是在转运途中进行治疗。本研究旨在评估家庭 OHCA 中高级生命支持（ALS）（即气管插管[ETI]或肾上腺素给药）时机与预后之间的关系。
这是一项使用日本 Utstein 登记处和从 2016 年至 2019 年接受院前 ETI（n=6806）和接受肾上腺素治疗的患者（n=22636）收集的紧急转运数据的回顾性队列研究。ETI 或肾上腺素给药的时机确定为“现场”或“救护车中”。使用多因素逻辑回归分析来估计 ALS 实施时机、院前自主循环恢复（ROSC）和 1 个月时生存之间的关联。
现场 ETI 与院前 ROSC（调整后的优势比[OR]，1.81；95%置信区间[CI]，1.57-2.09）和 1 个月时的生存（OR，1.81；95% CI，1.47-2.23）显著正相关。现场肾上腺素给药与院前 ROSC（OR，2.51；95% CI，2.33-2.70）和 1 个月时生存（OR，2.13；95% CI，1.89-2.40）显著正相关。
我们的分析表明，现场进行 ALS 与院前 ROSC 和 1 个月时的生存有关。需要进一步努力，通过急救救生员提高现场 ALS 实施率。
