Benkendorf R, Swor R A, Jackson R, Rivera-Rivera E J, Demrick A
Department of Emergency Medicine, Lapeer Regional Medical Hospital, MI, USA.
Prehosp Emerg Care. 1997 Apr-Jun;1(2):68-72. doi: 10.1080/10903129708958790.
To compare EMS system characteristics and outcomes between nursing home (NH) patients and out-of-hospital cardiac arrest (OHCA) patients whose arrests occurred in a residence (home).
Prospective cohort study reviewing OHCA from July 1989 to December 1993. Variables were age, witnessed arrest, response intervals, automated external defibrillator (AED) use, and arrest rhythms. Outcomes were hospital admission and discharge. Pearson chi-square was used for analysis.
Suburban EMS system.
Patients > or = 19 years old with arrest of presumed cardiac cause, with locations at home or at a NH.
2,348 total arrests were complete for analysis, 182 at a NH and 2,166 at home. BLS and ALS response intervals were shorter for the NH patients. The NH patients were more likely to receive CPR on collapse, were older (73.1 vs 67.5 years, p < 0.001), were less likely to have had an AED used (9.9% vs 30.0%, p < 0.001), and were more likely to have an arrest bradyasystolic rhythm (74.7% vs 51.5%, p < 0.001). They were less likely to survive to hospital admission (10.4% vs 18.5%, p < 0.006) and discharge (0.0% vs 5.6%, p < 0.001).
During this four-and-a-half-year study period, no NH patient survived, even though % CPR was increased. Arrest rhythm is an important factor in this finding. EMS initial care for ventricular tachycardia/fibrillation NH patients, with less application of AEDs, was identified. This different response may adversely contribute to dismal NH outcome.
比较疗养院（NH）患者与在住所（家中）发生院外心脏骤停（OHCA）患者的急救医疗服务（EMS）系统特征及预后。
对1989年7月至1993年12月期间的院外心脏骤停进行回顾性研究的前瞻性队列研究。变量包括年龄、目击骤停情况、反应间隔时间、自动体外除颤器（AED）使用情况及骤停心律。结局指标为入院及出院情况。采用Pearson卡方检验进行分析。
郊区急救医疗服务系统。
年龄大于或等于19岁、推测为心脏原因导致骤停、地点在家中或疗养院的患者。
共有2348例骤停病例可供完整分析，其中182例发生在疗养院，2166例发生在家中。疗养院患者的基础生命支持（BLS）和高级生命支持（ALS）反应间隔时间更短。疗养院患者在心跳骤停时更有可能接受心肺复苏（CPR），年龄更大（73.1岁对67.5岁，p<0.001），使用AED的可能性更小（9.9%对30.0%，p<0.001），发生心脏停搏-缓慢性心律失常的可能性更大（74.7%对51.5%，p<0.001）。他们存活至入院（10.4%对18.5%，p<0.006）及出院（0.0%对5.6%，p<0.001）的可能性更小。
在这四年半的研究期间，尽管心肺复苏率有所提高，但没有疗养院患者存活。骤停心律是这一结果的重要因素。已确定急救医疗服务对室性心动过速/心室颤动的疗养院患者初始治疗时AED应用较少。这种不同的反应可能对疗养院患者的不良预后产生不利影响。
