Vincent Thomas, Lefebvre Tiphaine, Martinez Mikaël, Debaty Guillaume, Noto-Campanella Cyril, Canon Valentine, Tazarourte Karim, Benhamed Axel
Services SAMU42-Urgences, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.
Réseau Urg'Ara, Lyon, France.
J Emerg Med. 2024 Dec;67(6):e533-e543. doi: 10.1016/j.jemermed.2024.06.008. Epub 2024 Jun 19.
Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown.
To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA.
A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used.
2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).
院外心脏骤停（OHCA）的存活率非常低。机构OHCA病例数量与患者预后之间的关联已有文献记载。然而，这是否适用于院前急救医疗服务（EMS）尚不清楚。
研究移动重症监护病房（MICU）的干预量与OHCA患者预后之间的关联。
一项回顾性队列研究，纳入2013年至2020年期间在法国五个中心由医疗EMS管理的成年OHCA患者。根据MICU干预的年度总数定义两组：低干预量MICU组和高干预量MICU组。主要终点是30天生存率。次要终点是院前自主循环恢复（ROSC）、入院时ROSC和良好的神经功能预后。使用倾向评分将患者1:1配对。然后使用条件逻辑回归。
分析了2014例成年患者（69%为男性，中位年龄68[57 - 79]岁），50.5%（n = 1017）由低干预量MICU管理，49.5%（n = 997）由高干预量MICU管理。低干预量组30天生存率为3.6%，高干预量组为5.1%。MICU干预量与30天生存率（OR = 0.92，95%CI[0.55；1.53]）、院前ROSC（OR = 1.01[0.78；1.3]）、入院时ROSC（OR = 0.92[0.69；1.21]）或30天良好神经功能预后（OR = 0.92[0.53；1.62]）之间无显著关联。
