尽管越来越多的证据表明有专门的心脏骤停中心,转运时间对院外心脏骤停(OHCA)患者转归的影响尚不清楚.我们系统回顾了运输时间对OHCA患者预后的影响。
我们搜索了PubMed,Embase,Cochrane图书馆,和WebofScience从开始到2016年5月的研究报告了OHCA患者的运输时间和结局之间的关系.主要结局是出院时的生存率。次要结局包括出院时的神经系统结局和长期结局。
从文献检索中检索到的3454个标题中,包括9项研究进行最终分析。所有9项研究(N=46,417)均为回顾性观察性研究。OHCA患者主要为男性(61-76%),在一半的病例中目睹了心脏骤停,三分之一的病例有最初的可电击节律。所有心律的出院总生存率小于6%。没有证据表明OHCA患者根据运输时间有不同的死亡风险(平均差异-0.05min[-0.86,0.76];I225%;4项研究,2197名患者)。
在成年OHCA患者中,护理人员转运时间与出院后的生存率或出院时的神经系统转归无关。未来的研究需要前瞻性评估运输时间对预后的影响,特别是在农村地区和儿科人群中。
Despite increasing evidence for specialized cardiac arrest centers, the impact of transport time on out-of-hospital cardiac arrest (OHCA) patients\' outcome remains unclear. We systematically reviewed the prognostic impact of transport time in OHCA patients.
We searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2016 for studies that had reported the relationship between transport time and outcome in OHCA patients. The primary outcome was survival at hospital discharge. The secondary outcomes included neurological outcome at hospital discharge and long-term outcome.
From a total of 3454 titles retrieved from the literature search, 9 studies were included for final analysis. All nine studies (N=46,417) were retrospective observational studies. OHCA patients included were mostly male (61-76%), suffered a witnessed cardiac arrest in half of the cases, and had an initial shockable rhythm in one third of cases. The overall survival to hospital discharge for all cardiac rhythms was less than 6%. There was no evidence for a differential mortality risk in OHCA patients according to transport time (mean difference -0.05min [-0.86,0.76]; I2 25%; 4 studies, 2197 patients).
Paramedic transport time was not associated with survival to hospital discharge or with neurological outcome at hospital discharge in adult OHCA patients. Future studies are needed to prospectively evaluate the prognostic impact of transport time particularly in rural settings and pediatric population.