de Vreede-Swagemakers J J, Gorgels A P, Dubois-Arbouw W I, van Ree J W, Daemen M J, Houben L G, Wellens H J
Department of Cardiology, University of Limburg, Maastricht, The Netherlands.
J Am Coll Cardiol. 1997 Nov 15;30(6):1500-5. doi: 10.1016/s0735-1097(97)00355-0.
We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands.
Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based study in the Maastricht area allows information on all victims of witnessed and unwitnessed SCA occurring outside the hospital.
Incidence, patient characteristics and survival rates were determined by prospectively collecting information on all cases of SCA occurring in the age group 20 to 75 years between January 1, 1991 and December 31, 1994. Survival rates were related to the site of the event (at home vs. outside the home) and the presence or absence of a witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA.
Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and 53% of women, SCA was most likely the first manifestation of heart disease. In patients known to have had a previous myocardial infarction (MI), the mean interval between the MI and SCA was 6.5 years, with >50% having a left ventricular ejection fraction >30%. The mean yearly incidence of SCA was 1 in 1,000 inhabitants. Of all deaths in the age groups studied, 18.5% were sudden. Nearly 80% of SCAs occurred at home. In 60% of all cases of SCA a witness was present. Cardiac resuscitation, which was attempted in 51% of all subjects, resulted overall in 32 (6%) of 515 patients being discharged alive from the hospital. Survival rates for witnessed SCA were 8% (16 of 208 subjects) at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to 18.8%).
The majority of victims of SCA cannot be identified before the event. Sudden cardiac arrest usually occurs at home, and the survival of those with a witnessed SCA at home was low compared with that outside the home, indicating the necessity of optimizing out-of-hospital resuscitation, especially in the at-home situation.
我们试图描述荷兰马斯特里赫特地区院外心脏骤停（SCA）的发生率、特征及生存率。
不同社区院外SCA的发生率及生存率通常基于急诊医疗服务机构复苏成功的患者数量。我们在马斯特里赫特地区开展的基于人群的研究涵盖了所有在院外发生的有目击者和无目击者的SCA患者信息。
通过前瞻性收集1991年1月1日至1994年12月31日期间年龄在20至75岁的所有SCA病例信息，确定其发生率、患者特征及生存率。生存率与事件发生地点（在家中与在家外）、院外SCA复苏尝试时是否有目击者以及心律有关。
共纳入515例患者（男性占72%，女性占28%）。44%的男性和53%的女性中，SCA很可能是心脏病的首发表现。在已知既往有心肌梗死（MI）的患者中，MI与SCA的平均间隔时间为6.5年，超过50%的患者左心室射血分数>30%。SCA的年平均发生率为每1000名居民中有1例。在所研究的年龄组中，所有死亡病例中有18.5%为猝死。近80%的SCA发生在家中。所有SCA病例中有60%有目击者。51%的受试者尝试进行了心脏复苏，总体上515例患者中有32例（6%）存活出院。有目击者的在家中发生的SCA生存率为8%（208例受试者中有16例），在家外发生的为18%（85例受试者中有15例）（95%置信区间为1%至18.8%）。
大多数SCA受害者在事件发生前无法被识别。心脏骤停通常发生在家中，在家中有目击者的SCA患者生存率低于在家外发生的患者，这表明优化院外复苏措施很有必要，尤其是在家中发生的情况。
