Paratz Elizabeth D, Hansen Carl Johann, Gerche Andre La, Stub Dion, Nehme Ziad, Dantanarayana Ashanti, Freedman Kelila, Pflaumer Andreas, Ingles Jodie, Winkel Bo Gregers, Tfelt-Hansen Jacob
Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
St Vincent's Institute of Medical Research, 9 Princes St, Fitzroy, VIC 3065, Australia.
Resusc Plus. 2025 Aug 5;25:101047. doi: 10.1016/j.resplu.2025.101047. eCollection 2025 Sep.
Out-of-hospital cardiac arrest (OHCA) on the toilet has been reported to be common and possibly driven by straining or vagal stimulus. Toilet-associated OHCA may also create a challenging resuscitation environment.
The national Danish sudden death registry and state-wide Australian End Unexplained Cardiac Death (EndUCD) registry were examined Persons with a fatal OHCA aged 5-50 years with autopsy-confirmed cardiac or unascertained aetiology were included. Resuscitation-related, aetiological and forensic factors were compared between persons experiencing fatal toilet-associated OHCA versus elsewhere. A composite variable of physiological conditions creating pressure-load or pressure-sensitivity was created, comprising hypertrophic cardiomyopathy, aortic stenosis/coarctation, and aortic aneurysm/dissection.
Of 2,463young persons, 75 (3.0 %) experienced toilet-associated fatal OHCA while 2,388 (97.0 %) experienced out-of-toilet OHCA. Australians experienced toilet-associated OHCA 1.7 times more frequently than Danes (4.1 % vs 2.4 %, = 0.016). Toilet-associated OHCA was less frequently witnessed (13.3 % vs 32.1 %, = 0.001), with lower rates of bystander cardiopulmonary resuscitation (32.0 % vs 55.7 %, < 0.0001) and shockable rhythm (5.9 % vs 23.8 %, = 0.003) compared to non-toilet OHCA. Toxicological results were more frequently positive for illicit substances in toilet-associated OHCA (32.8 % vs 16.3 %, < 0.0001). No differences were identified in OHCA aetiology, including rates of the composite variable of aetiologies such as hypertrophic cardiomyopathy and aortic dissection.
3.0 % of young fatal OHCA of cardiac aetiology is toilet-associated, with almost double the rates of toilet-associated OHCA in Australia compared to Denmark. No differences in OHCA aetiology were identified in toilet-associated OHCA. Resuscitation-related factors were adverse in toilet-related OHCA, highlighting the need for innovative ways to recognise and respond to toilet-associated OHCA.
据报道，在厕所发生的院外心脏骤停（OHCA）很常见，可能由用力排便或迷走神经刺激引起。与厕所相关的OHCA也可能造成具有挑战性的复苏环境。
对丹麦国家猝死登记处和澳大利亚全州范围的不明原因心脏死亡（EndUCD）登记处进行了检查。纳入年龄在5至50岁之间、经尸检证实为心脏病因或病因不明的致命OHCA患者。比较了与厕所相关的致命OHCA患者和其他地方患者的复苏相关、病因和法医因素。创建了一个产生压力负荷或压力敏感性的生理状况复合变量，包括肥厚型心肌病、主动脉瓣狭窄/缩窄和主动脉瘤/夹层。
在2463名年轻人中，75人（3.0%）经历了与厕所相关的致命OHCA，而2388人（97.0%）经历了厕所外的OHCA。澳大利亚人经历与厕所相关的OHCA的频率是丹麦人的1.7倍（4.1%对2.4%，P = 0.016）。与厕所相关的OHCA较少被目击（13.3%对32.1%，P = 0.001），与非厕所OHCA相比，旁观者心肺复苏率较低（32.0%对55.7%，P < 0.0001），可电击心律发生率较低（5.9%对23.8%，P = 0.003）。与厕所相关的OHCA中非法物质的毒理学结果阳性更为常见（32.8%对16.3%，P < 0.0001）。在OHCA病因方面未发现差异，包括肥厚型心肌病和主动脉夹层等病因复合变量的发生率。
3.0%的心脏病因导致的年轻致命OHCA与厕所相关，澳大利亚与厕所相关的OHCA发生率几乎是丹麦的两倍。在与厕所相关的OHCA中未发现OHCA病因的差异。与厕所相关的OHCA中与复苏相关的因素不利，突出了需要创新方法来识别和应对与厕所相关的OHCA。
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