School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia.
Open Heart. 2024 Sep 30;11(2):e002799. doi: 10.1136/openhrt-2024-002799.
Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.
This is a retrospective cohort study of consecutive ambulance attendances for non-traumatic shock in Victoria, Australia (January 2015-June 2019) linked with government-held administrative data (emergency, admissions and mortality records). Predictors of 30-day mortality were assessed using Cox proportional regressions. The primary outcome was 30-day all-cause mortality.
Overall, 21 334 patients with non-traumatic shock (median age 69 years, 54.8% female) were successfully linked with state administrative records. Among this cohort, 9 149 (43%) patients died within 30-days. Compared with survivors, non-survivors had a longer median on-scene time: 60 (35-98) versus 30 (19-50), p <0.001. Non-survivors were more likely to be older (median age in years: 74 (61-84) vs 65 (47-78), p<0.001), had prehospital cardiac arrest requiring cardiopulmonary resuscitation (adjusted HR (aHR)=6.26, 95% CI 5.87, 6.69) and had prehospital intubation (aHR=1.07, CI 1.00, 1.14). Reduced 30-day mortality was associated with administration of epinephrine (aHR=0.66, CI 0.62, 0.71) and systolic blood pressures above 80 mm Hg in the prehospital setting.
The 30-day mortality from non-traumatic shock is high at 43%. Independent predictors of mortality included age, prehospital cardiac arrest and endotracheal intubation. Interventions that target reversible causes of short-term mortality in patients with non-traumatic shock are a high priority.
接受急诊医疗服务（EMS）治疗的休克患者发病率和死亡率较高。对于预测休克患者结局的院前因素，我们知之甚少。本研究旨在描述院前非创伤性休克患者的预后预测因素。
这是一项回顾性队列研究，对澳大利亚维多利亚州（2015 年 1 月至 2019 年 6 月）的连续救护车出勤情况进行了研究，将其与政府持有的行政数据（急救、入院和死亡率记录）进行了关联。使用 Cox 比例风险回归评估 30 天死亡率的预测因素。主要结局是 30 天全因死亡率。
共有 21334 例非创伤性休克患者（中位年龄 69 岁，54.8%为女性）成功与州行政记录相关联。在该队列中，9149 例（43%）患者在 30 天内死亡。与幸存者相比，非幸存者的现场中位时间更长：60 分钟（35-98）与 30 分钟（19-50），p<0.001。非幸存者更有可能年龄较大（中位数年龄，岁：74[61-84]与 65[47-78]，p<0.001），需要院前心肺复苏的心脏骤停（调整后的 HR（aHR）=6.26，95%CI 5.87，6.69）和院前插管（aHR=1.07，95%CI 1.00，1.14）。30 天死亡率降低与院前使用肾上腺素（aHR=0.66，95%CI 0.62，0.71）和收缩压高于 80mmHg 相关。
非创伤性休克的 30 天死亡率为 43%，很高。死亡率的独立预测因素包括年龄、院前心脏骤停和气管插管。针对非创伤性休克患者短期死亡率的可逆原因的干预措施是重中之重。
