俄亥俄州院外心脏骤停复苏表现及结果的差异
Variations in Out-of-Hospital Cardiac Arrest Resuscitation Performance and Outcomes in Ohio.
作者信息
Nassal Michelle M J, Wang Henry E, Powell Jonathan R, Benoit Justin L, Panchal Ashish R
机构信息
The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio.
出版信息
West J Emerg Med. 2025 Mar 15;26(3):541-548. doi: 10.5811/westjem.19422.
INTRODUCTION
Understanding characteristics of top-performing emergency medical service (EMS) agencies and hospitals can be an important tool for improving community out-of-hospital cardiac arrest (OHCA) care. We compared deidentified EMS and hospital-level variations in OHCA performance and outcomes in Ohio.
METHODS
We analyzed adult OHCA data from the 2019 Ohio Cardiac Arrest Registry to Enhance Survival (Ohio CARES). We limited the analysis to EMS agencies and receiving hospitals with ≥10 OHCA episodes. The primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge. We compared OHCA outcomes between EMS agencies using linear mixed models, with EMS agency as a random effect and adjusting for Utstein variables. We repeated the analysis by receiving hospital. We compared EMS agency population demographics, response times, and resuscitation characteristics of the top 10% of agencies against remaining agencies using chi-squared tests.
RESULTS
We included 2,841 OHCA among 44 EMS agencies in our analysis. The ROSC varied three-fold; mean 27.9%, range 15.8%‒51.0%. Among 40 hospitals, survival varied two-fold; mean 12.9%, range 8.1%‒19.0%. Top-performing EMS agencies included both medium- and large-sized agencies that tended to treat younger patients (59 vs 62 years, P<0.01) in public areas (15.7% vs 12.3%, P<0.01). There were no differences in bystander-witnessed arrest, bystander cardio-pulmonary resuscitation (CPR), or EMS response time. However, top-performing EMS agencies used less mechanical CPR (61.7% vs 76.0%, P<0.01) and were more successful in advanced airway placement (89.6% vs 74.8% P<0.01).
CONCLUSIONS
The ROSC and survival after out-of-hospital cardiac arrest varied across EMS agencies and hospitals in Ohio. Top-performing EMS agencies exhibited unique demographic characteristics, used less mechanical CPR, and were more successful in airway placement. These variations in OHCA care and outcomes can indicate opportunities for system improvement in Ohio.
引言
了解表现卓越的紧急医疗服务（EMS）机构和医院的特点，可能是改善社区院外心脏骤停（OHCA）护理的一项重要工具。我们比较了俄亥俄州经去识别化处理的EMS和医院层面在OHCA表现及结果方面的差异。
方法
我们分析了来自2019年俄亥俄州心脏骤停登记以提高生存率（Ohio CARES）的成年OHCA数据。我们将分析限制在有≥10例OHCA事件的EMS机构和接收医院。主要结局是自主循环恢复（ROSC）和存活至出院。我们使用线性混合模型比较了EMS机构之间的OHCA结局，将EMS机构作为随机效应，并对Utstein变量进行调整。我们按接收医院重复了该分析。我们使用卡方检验比较了排名前10%的机构与其余机构的EMS机构人口统计学、反应时间和复苏特征。
结果
我们的分析纳入了44个EMS机构中的2841例OHCA。ROSC差异达三倍；平均为27.9%，范围为15.8%至51.0%。在40家医院中，存活率差异达两倍；平均为12.9%，范围为8.1%至19.0%。表现卓越的EMS机构包括中型和大型机构，这些机构往往在公共场所治疗更年轻的患者（59岁对62岁，P<0.01）（15.7%对12.3%，P<0.01）。在旁观者目击的心脏骤停、旁观者心肺复苏（CPR）或EMS反应时间方面没有差异。然而，表现卓越的EMS机构使用机械CPR较少（61.7%对76.0%，P<0.01），并且在高级气道放置方面更成功（89.6%对74.8%，P<0.01）。
结论
俄亥俄州不同的EMS机构和医院在院外心脏骤停后的ROSC和存活率有所不同。表现卓越的EMS机构呈现出独特的人口统计学特征，使用机械CPR较少，并且在气道放置方面更成功。OHCA护理和结局的这些差异可能表明俄亥俄州系统改进的机会。
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