Nehme Emily, Anderson David, Salathiel Ross, Carlyon Anthony, Stub Dion, Cameron Peter A, Wilson Andrew, Smith Sile, McNeil John J, Nehme Ziad
Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC.
Monash University, Melbourne, VIC.
Med J Aust. 2024 Dec 9;221(11):603-611. doi: 10.5694/mja2.52532. Epub 2024 Nov 18.
To examine changes in out-of-hospital cardiac arrest (OHCA) characteristics and outcomes during 2003-2022, and 12-month outcomes for people who experienced OHCA during 1 January 2010 - 30 June 2022.
Retrospective observational study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.
SETTING, PARTICIPANTS: OHCA events in Victoria not witnessed by emergency medical services personnel, 1 January 2003 - 31 December 2022.
Crude and age-standardised annual OHCA incidence rates; survival to hospital discharge.
Of 102 592 OHCA events included in our analysis, 67 756 were in men (66.3%). The age-standardised incidence did not change significantly across the study period (2003: 89.1 cases, 2022: 91.2 cases per 100 000 population; for trend: P = 0.50). The proportion of OHCA cases with attempted resuscitation by emergency medical services in which bystanders attempted cardio-pulmonary resuscitation increased from 40.3% in 2003/2004 to 72.2% in 2021/2022, and that of public access defibrillation from 0.9% to 16.1%. In the Utstein comparator group (witnessed OHCA events in which the initial cardiac rhythm was ventricular fibrillation or ventricular tachycardia, with attempted resuscitation by emergency medical services), the odds of survival to hospital discharge increased during 2003-2022 (adjusted odds ratio (aOR), 3.08; 95% confidence interval [CI], 2.22-4.27); however, the odds of survival was greater than in 2012 only in 2018 (aOR, 1.37; 95% CI, 1.04-1.80) and 2019 (aOR, 1.68; 95% CI, 1.28-2.21). The COVID-19 pandemic was associated with reduced odds of survival (aOR, 0.63; 95% CI, 0.54-0.74). Of 3161 people who survived OHCA and participated in 12-month follow-up, 1218 (38.5%) reported full health according to the EQ-5D.
Utstein survival to hospital discharge increased threefold during 2003-2022, and the proportions of cases in which bystanders provided cardio-pulmonary resuscitation or public access defibrillation increased. The COVID-19 pandemic was associated with a substantial reduction in survival, and new strategies are needed to improve outcomes.
研究2003年至2022年期间院外心脏骤停（OHCA）的特征和结局变化，以及2010年1月1日至2022年6月30日期间经历OHCA者的12个月结局。
回顾性观察研究；对维多利亚州救护车心脏骤停登记处（VACAR）数据进行分析。
背景、参与者：2003年1月1日至2022年12月31日期间，维多利亚州未被紧急医疗服务人员目击的OHCA事件。
粗年发病率和年龄标准化年发病率；存活至出院。
在我们分析的102592例OHCA事件中，67756例为男性（66.3%）。在整个研究期间，年龄标准化发病率没有显著变化（2003年：每10万人口89.1例，2022年：每10万人口91.2例；趋势分析：P = 0.50）。在紧急医疗服务人员尝试进行复苏的OHCA病例中，旁观者尝试进行心肺复苏的比例从2003/2004年的40.3%增加到2021/2022年的72.2%，公众可及除颤的比例从0.9%增加到16.1%。在Utstein比较组（初始心律为室颤或室速且紧急医疗服务人员尝试进行复苏的目击OHCA事件）中，2003年至2022年期间存活至出院的几率增加（调整优势比（aOR），3.08；95%置信区间[CI]，2.22 - 4.27）；然而，仅在2018年（aOR，1.37；95% CI，1.04 - 1.80）和2019年（aOR，1.68；95% CI，1.28 - 2.21）存活几率高于2012年。COVID-19大流行与存活几率降低相关（aOR，0.63；95% CI，0.54 - 0.74）。在3161例OHCA存活且参加12个月随访的患者中，1218例（38.5%）根据EQ-5D报告健康状况良好。
2003年至2022年期间，Utstein模式下存活至出院的几率增加了两倍，旁观者进行心肺复苏或公众可及除颤的病例比例增加。COVID-19大流行与存活几率大幅降低相关，需要新的策略来改善结局。
