Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
Tokyo Fire Department, 1-3-5, Otemachi, Chiyoda-ku, Tokyo 100-8119, Japan.
Resuscitation. 2024 Sep;202:110303. doi: 10.1016/j.resuscitation.2024.110303. Epub 2024 Jul 6.
Patients with the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) are unstable and often experience rearrest, after which ROSC may be reattained. This study investigated the incidence and risk factors of post-ROSC events (rearrest and subsequent reattainment of ROSC) and their impact on outcomes in patients with prehospital ROSC following OHCA.
Patients with OHCA and prehospital ROSC were identified from the Tokyo Fire Department database between 1 January 2018 and 31 December 2022. The factors associated with post-ROSC events and their impact on 1-month favourable neurological outcome (cerebral performance category scale: 1 or 2) were assessed using multivariable logistic regression analysis.
Overall, 64,000 individuals experienced OHCA, and 6,190 (9.7%) had ROSC. Rearrest was confirmed in 28.4% of patients with ROSC, and was associated with age, time of emergency call, location of cardiac arrest, dispatcher instruction regarding cardiopulmonary resuscitation, first recorded cardiac rhythm, bystander cardiopulmonary resuscitation, defibrillation by a bystander, response time, and prehospital interventions. ROSC reattainment was confirmed in 34.5% of patients with rearrest and associated with the first recorded cardiac rhythm and defibrillation by a bystander. Patients without rearrests had the highest proportion of favourable neurological outcomes, followed by those with solved and unsolved rearrests (38.6% vs. 22.4% and 4.4%, P < 0.001). The difference remained significant after adjustment for confounders.
This study revealed population-based incidence and risk factors of post-ROSC events. Rearrest was common, leading to unfavourable neurological outcome; however, its deleterious impact may be mitigated by successful resuscitation efforts.
院外心脏骤停（OHCA）后自主循环恢复（ROSC）的患者不稳定，经常再次发生骤停，之后 ROSC 可能再次恢复。本研究调查了 OHCA 后院前 ROSC 患者的再 ROSC 事件（骤停后再次发生 ROSC）的发生率和危险因素及其对结局的影响。
从 2018 年 1 月 1 日至 2022 年 12 月 31 日，从东京消防署数据库中确定了 OHCA 且院前 ROSC 的患者。使用多变量逻辑回归分析评估与再 ROSC 事件相关的因素及其对 1 个月时良好神经结局（脑功能分类量表：1 或 2）的影响。
总体而言，64000 人经历了 OHCA，其中 6190 人（9.7%）出现 ROSC。28.4%的 ROSC 患者确认发生再骤停，与年龄、紧急呼救时间、心脏骤停地点、调度员心肺复苏指导、首次记录的心脏节律、旁观者心肺复苏、旁观者除颤、反应时间和院前干预有关。34.5%的再骤停患者确认 ROSC 再次恢复，与首次记录的心脏节律和旁观者除颤有关。无再骤停的患者具有良好神经结局的比例最高，其次是解决和未解决再骤停的患者（38.6%比 22.4%和 4.4%，P<0.001）。调整混杂因素后差异仍有统计学意义。
本研究揭示了基于人群的再 ROSC 事件发生率和危险因素。再骤停很常见，导致不良神经结局；然而，成功的复苏努力可能减轻其有害影响。
