Pöss Janine, Sinning Christoph, Roßberg Michelle, Hösler Nadine, Ouarrak Taoufik, Böttiger Bernd W, Ewen Sebastian, Wienbergen Harm, Voss Fabian, Dutzmann Jochen, Tigges Eike, Voigt Ingo, Freund Anne, Desch Steffen, Michels Guido, Thiele Holger, Zeymer Uwe
Leipzig Heart Center, Leipzig, Germany.
University Heart & Vascular Center Hamburg, Hamburg, Germany.
Clin Res Cardiol. 2024 Jun 13. doi: 10.1007/s00392-024-02468-5.
In Europe, more than 300,000 persons per year experience out-of-hospital cardiac arrest (OHCA). Despite medical progress, only few patients survive with good neurological outcome. For many issues, evidence from randomized trials is scarce. OHCA often occurs for cardiac causes. Therefore, we established the national, prospective, multicentre German Cardiac Arrest Registry (G-CAR). Herein, we describe the first results of the pilot phase.
Over a period of 16 months, 15 centres included 559 consecutive OHCA patients aged ≥ 18 years. The median age of the patients was 66 years (interquartile range 57;75). Layperson resuscitation was performed in 60.5% of all OHCA cases which were not observed by emergency medical services. The initial rhythm was shockable in 46.4%, and 29.1% of patients had ongoing CPR on hospital admission. Main presumed causes of OHCA were acute coronary syndromes (ACS) and/or cardiogenic shock in 54.8%, with ST-elevation myocardial infarction being the most common aetiology (34.6%). In total, 62.9% of the patients underwent coronary angiography; percutaneous coronary intervention (PCI) was performed in 61.4%. Targeted temperature management was performed in 44.5%. Overall in-hospital mortality was 70.5%, with anoxic brain damage being the main presumed cause of death (38.8%). Extracorporeal cardiopulmonary resuscitation (eCPR) was performed in 11.0%. In these patients, the in-hospital mortality rate was 85.2%.
G-CAR is a multicentre German registry for adult OHCA patients with a focus on cardiac and interventional treatment aspects. The results of the 16-month pilot phase are shown herein. In parallel with further analyses, scaling up of G-CAR to a national level is envisaged. Trial registration ClinicalTrials.gov identifier: NCT05142124.
在欧洲，每年有超过30万人发生院外心脏骤停（OHCA）。尽管医学取得了进展，但只有少数患者能存活且神经功能预后良好。对于许多问题，随机试验的证据很少。OHCA通常由心脏原因引起。因此，我们建立了全国性、前瞻性、多中心的德国心脏骤停登记处（G-CAR）。在此，我们描述试点阶段的首批结果。
在16个月的时间里，15个中心纳入了559例年龄≥18岁的连续OHCA患者。患者的中位年龄为66岁（四分位间距57；75）。在所有未被紧急医疗服务人员观察到的OHCA病例中，60.5%进行了非专业人员心肺复苏。初始心律可电击复律的占46.4%，29.1%的患者入院时正在进行心肺复苏。OHCA的主要推测原因是急性冠状动脉综合征（ACS）和/或心源性休克，占54.8%，其中ST段抬高型心肌梗死是最常见的病因（34.6%）。总体而言，62.9%的患者接受了冠状动脉造影；61.4%的患者进行了经皮冠状动脉介入治疗（PCI）。44.5%的患者进行了目标温度管理。总体院内死亡率为70.5%，缺氧性脑损伤是主要的推测死亡原因（38.8%）。11.0%的患者进行了体外心肺复苏（eCPR）。在这些患者中，院内死亡率为85.2%。
G-CAR是一个针对成年OHCA患者的多中心德国登记处，重点关注心脏和介入治疗方面。本文展示了16个月试点阶段的结果。在进行进一步分析的同时，设想将G-CAR扩大到全国范围。试验注册ClinicalTrials.gov标识符：NCT05142124。
