Finke K, Meertens M M, Macherey-Meyer S, Heyne S, Braumann S, Baldus S, Lee S, Adler C
Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Center of Cardiology, Cardiology III - Angiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Resusc Plus. 2024 Aug 6;19:100742. doi: 10.1016/j.resplu.2024.100742. eCollection 2024 Sep.
Physical activity prevents cardiovascular disease, but it may also trigger acute cardiac events like sudden cardiac death in patients with underlying heart disease. The chance of surviving an out-of-hospital cardiac arrest remains low, despite improving medical treatment and rescue chain. Prior studies signaled increased survival in exercise related out-of-hospital cardiac arrest.
The aim of this study was to evaluate the differences between exercise related out-of-hospital cardiac arrest and out-of-hospital cardiac arrest during daily activity in an urban setting.
Retrospective analysis of all out-of-hospital cardiac arrests from 2014 to 2021 treated at a cardiac arrest center of a tertiary hospital. The primary outcome was survival to discharge. Secondary outcomes included differences in pre-hospital care, in-hospital treatment, hypoxic ischemic encephalopathy, and laboratory parameters.
478 OHCA patients were reviewed of which 432 patients (exercise related 36 (8.4%) vs. daily activity 396 (91.6%)) were included in the analysis. Patients suffering an exercise related arrest were younger (57 vs 65 years, = 0.002) and mostly male (88.9 vs 74.5%, = 0.054).The exercise related cohort received bystander cardiopulmonary resuscitation (77.8 vs 53.4%, = 0.005) to a higher extent and had a shorter no-flow time (1.5 vs 2 min, = 0.049). Exercise related arrest patients more often presented with a shockable rhythm (80.6 vs 64.1%, = 0.032).At hospital admission exercise related arrest patients had a higher initial pH (7.24 vs 7.19, = 0.015). In the exercise related group, a cardiac cause was numerically more frequent compared to the daily activity group (80.6 vs 68.7%, = 0.09). In both groups myocardial infarction (47.2 vs 43.2%) was the most common cause, but a primary arrhythmic event (33.3 vs 25.5%) was more often documented in exercise related arrest patients. Exercise related arrest was mostly related to endurance training (52.8%) followed by ball sports (19.4%) and occurred directly during exercise in 77.8% of cases. Patients suffering exercise related arrest had higher survival till discharge (66.7 vs 47.7%, = 0.036).
Based on this observational data from a highly selected group of out-of-hospital cardiac arrest patients treated at a cardiac arrest center, patients suffering an exercise related out-of-hospital cardiac arrest, differed in substantial characteristics and in the first line response compared to daily activity out-of-hospital cardiac arrest patients. The better survival to discharge of the exercise related out-of-hospital cardiac arrest group might be driven by these beneficial differences. This study underlines the need for public awareness for the importance of a fast first response and a broad distribution of automated external defibrillators in public sport areas since most of the exercise related out-of-hospital cardiac arrest patients presented with a cardiac cause and an initial shockable rhythm.
体育活动可预防心血管疾病，但也可能引发急性心脏事件，如潜在心脏病患者的心脏性猝死。尽管医疗救治和救援链有所改善，但院外心脏骤停的存活几率仍然很低。先前的研究表明，与运动相关的院外心脏骤停患者的存活率有所提高。
本研究旨在评估城市环境中与运动相关的院外心脏骤停和日常活动期间院外心脏骤停之间的差异。
对一家三级医院心脏骤停中心2014年至2021年治疗的所有院外心脏骤停病例进行回顾性分析。主要结局是出院存活率。次要结局包括院前护理、院内治疗、缺氧缺血性脑病和实验室参数的差异。
共审查了478例院外心脏骤停患者，其中432例患者（与运动相关的36例（8.4%） vs. 日常活动的396例（91.6%））纳入分析。与运动相关的心脏骤停患者更年轻（57岁 vs. 65岁，P = 0.002），且大多为男性（88.9% vs. 74.5%，P = 0.054）。与运动相关的队列接受旁观者心肺复苏的比例更高（77.8% vs. 53.4%，P = 0.005），且无血流时间更短（1.5分钟 vs. 2分钟，P = 0.049）。与运动相关的心脏骤停患者更常出现可电击心律（80.6% vs. 64.1%，P = 0.032）。入院时，与运动相关的心脏骤停患者初始pH值更高（7.24 vs. 7.19，P = 0.015）。在与运动相关的组中，心脏病因在数量上比日常活动组更常见（80.6% vs. 68.7%，P = 0.09）。在两组中，心肌梗死都是最常见的病因（47.2% vs. 43.2%），但与运动相关的心脏骤停患者中，原发性心律失常事件更常被记录（33.3% vs. 25.5%）。与运动相关的心脏骤停大多与耐力训练有关（52.8%），其次是球类运动（19.4%），77.8%的病例在运动期间直接发生。与运动相关的心脏骤停患者出院存活率更高（66.7% vs. 47.7%，P = 0.036）。
基于在心脏骤停中心治疗的一组高度选择的院外心脏骤停患者的观察数据，与日常活动期间院外心脏骤停患者相比，与运动相关的院外心脏骤停患者在显著特征和一线反应方面存在差异。与运动相关的院外心脏骤停组更好的出院存活率可能是由这些有益差异驱动的。本研究强调了提高公众意识的必要性，即快速的第一反应以及在公共体育区域广泛配备自动体外除颤器的重要性，因为大多数与运动相关的院外心脏骤停患者表现为心脏病因和初始可电击心律。
