Harrysson Linn, Blick Emma, Awad Akil, Jonsson Martin, Claesson Andreas, Magnusson Carl, Abazi Lis, Israelsson Johan, Hofmann Robin, Nordberg Per, Riva Gabriel
Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset (KI SÖS), Karolinska Institute, Stockholm, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Resuscitation. 2024 Dec;205:110435. doi: 10.1016/j.resuscitation.2024.110435. Epub 2024 Nov 15.
INTRODUCTION/AIM: Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA.
This is a registry-based retrospective cohort study based on data reported by the emergency medical services to the Swedish Registry of Cardiopulmonary Resuscitation and the National Patient Registry. All OHCA patients aged 18 years or older with an initial shockable rhythm in Sweden from January 1, 2010 and December 31, 2020 were included. Exposure was total number of defibrillations, and primary outcome was survival to 30 days. Logistic regression was used to adjust for patient and resuscitation characteristics.
Over the study period a total of 10,549 patients were included. Among them, 3,006 (28.5%) received only one shock, 1,665 (15.8%) two shocks, 1,336 (12.9%) three shocks, 1,064 (10.1%) four shocks and 3,478 (33.0%) five or more shocks. In the adjusted analysis an exponential decrease in the 30-day survival was found for each additional defibrillation. For patients receiving one, two, three and four defibrillations, the adjusted probability of survival was 42%, 36%, 30% and 25% respectively.
In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.
引言/目的：院外心脏骤停（OHCA）伴有可电击除颤的无脉性室性心动过速或心室颤动且对除颤无反应是一项医学挑战。针对所谓对三次或更多次除颤无反应的难治性心室颤动，已经出现了新的治疗策略，但这些策略的最佳时机的证据却很少。这项观察性研究的主要目的是评估院外心脏骤停中除颤总数与生存率之间的关系。
这是一项基于登记处的回顾性队列研究，数据来源于紧急医疗服务机构向瑞典心肺复苏登记处和国家患者登记处报告的数据。纳入了2010年1月1日至2020年12月31日在瑞典所有年龄18岁及以上且初始心律可电击除颤的院外心脏骤停患者。暴露因素为除颤总数，主要结局为30天生存率。采用逻辑回归对患者和复苏特征进行校正。
在研究期间，共纳入10549例患者。其中，3006例（28.5%）仅接受一次电击，1665例（15.8%）接受两次电击，1336例（12.9%）接受三次电击，1064例（10.1%）接受四次电击，3478例（33.0%）接受五次或更多次电击。在校正分析中，发现每增加一次除颤，30天生存率呈指数下降。接受一次、两次、三次和四次除颤的患者，校正后的生存概率分别为42%、36%、30%和25%。
在这项基于登记处的回顾性队列研究中，额外的除颤与较低的生存率相关。在对患者和复苏特征进行校正后，这种关联仍然存在。
