Stratton S J, Niemann J T
University of California-Los Angeles School of Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, USA.
Ann Emerg Med. 1998 Oct;32(4):448-53. doi: 10.1016/s0196-0644(98)70174-x.
Studies indicate that ventricular tachycardia (VT) and ventricular fibrillation (VF) are no longer the most common rhythms initially documented in out-of-hospital sudden cardiac death. Although the outcome from asystole and rhythms designated as pulseless electrical activity (PEA) is reported as poor (approximately 1% survival), resuscitative efforts for these patients are still encouraged. The purpose of this study was to determine the potential contribution that this patient group makes to overall survivorship.
During this 2-year prospective study, all patients in cardiopulmonary arrest who were transported to the study institution after out-of-hospital Advanced Cardiac Life Support (ACLS) interventions were considered eligible for inclusion. Patients younger than 18 years of age and those in posttraumatic arrest were excluded. Age, sex, first-documented arrest rhythm, presence of a witness to the arrest, performance of bystander CPR, survival to hospital discharge, and functional status at discharge were recorded.
A total of 197 patients met the inclusion criteria. The initial rhythm was VF/VT in 59 (30%; 95% confidence interval [CI], 24% to 37%) and asystole/PEA in 138 (70%; 95% CI, 64% to 76%). There was 1 hospital survivor in the VT/VF group; 9 patients (7%; 95% CI, 4% to 13%) in the asystole/PEA group survived to hospital discharge. Of the asystole/PEA survivors, 100% (95% CI, 66% to 100%) had a witnessed arrest and 56% (95% CI, 21% to 86%) received bystander CPR. Fifty-six percent (95% CI, 21% to 86%) of the asystole/PEA survivors were discharged at a functional level equivalent to that preceding arrest.
In this study, patients in asystole/PEA comprised 90% of the survivors. The outcome for patients with asystole/PEA whose arrest was witnessed and who received bystander CPR may be greater than previously estimated and supports the current practice of initiating aggressive out-of-hospital ACLS in this patient group.
研究表明，室性心动过速（VT）和室性颤动（VF）不再是院外心脏性猝死最初记录的最常见心律。尽管无脉电活动（PEA）和心脏停搏的患者预后较差（生存率约为1%），但仍鼓励对这些患者进行复苏努力。本研究的目的是确定该患者群体对总体生存率的潜在贡献。
在这项为期2年的前瞻性研究中，所有在院外高级心脏生命支持（ACLS）干预后被转运至研究机构的心脏骤停患者均被认为符合纳入标准。排除年龄小于18岁的患者和创伤后心脏骤停患者。记录患者的年龄、性别、首次记录的心脏骤停心律、是否有心脏骤停目击者、旁观者心肺复苏（CPR）的实施情况、出院生存率以及出院时的功能状态。
共有197例患者符合纳入标准。初始心律为VF/VT的有59例（30%；95%置信区间[CI]，24%至37%），心脏停搏/PEA的有138例（70%；95%CI，64%至76%）。VT/VF组有1例患者存活至出院；心脏停搏/PEA组有9例患者（7%；95%CI，4%至13%）存活至出院。在心脏停搏/PEA组的存活患者中，100%（95%CI，66%至100%）有心脏骤停目击者，56%（95%CI，21%至86%）接受了旁观者CPR。心脏停搏/PEA组的存活患者中有56%（95%CI，21%至86%）出院时的功能状态与心脏骤停前相当。
在本研究中，心脏停搏/PEA患者占存活者的90%。心脏停搏/PEA且有心脏骤停目击者并接受旁观者CPR的患者的预后可能比先前估计的要好，这支持了目前对该患者群体实施积极的院外ACLS的做法。
