■评估2020年冠状病毒病(COVID-19)大流行对老年人院前特征和院外心脏骤停(OHCA)结局的影响。
■在日本的这项基于人口的全国性观察研究中,分析了563,100例涉及任何院前复苏工作的老年(≥65岁)患者的急诊医疗服务-目击OHCA(分别在2020年,2019年,2018年和2017年分别为144,756、140,741、140,610和136,993例)。流行病学,特点,在大流行前3年(2017-2019年)和大流行年(2020年)之间,比较了老年患者与OHCA相关的结局.主要结果是神经系统有利的一个月生存率。次要结果是旁观者心肺复苏(CPR)的发生率,由旁观者进行除颤,调度员辅助(DA)-CPR尝试,和一个月的生存。
■在大流行年,神经系统有利的1个月生存率(粗比值比,95%置信区间:1.19,1.14-1.25),旁观者CPR(1.04,1.03-1.06),DA-CPR尝试(1.10,1.08-1.11)增加,而公共通道除颤的发生率(0.88,0.83-0.93)下降。基于相互作用测试的亚组分析显示,在大流行年中,OHCA在护理机构中的神经系统有利生存率增加(1.51,1.36-1.68),在紧急状态日减少或取消(0.90,0.74-1.09),在主要受影响的州(1.08,1.01-1.15),以及具有可电击初始节律(1.03,0.96-1.12)的情况。
COVID-19大流行与DA-CPR尝试增强相关,增加了旁观者的CPR率,并改善了OHCA老年患者的预后。
UNASSIGNED: To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly.
UNASSIGNED: In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival.
UNASSIGNED: During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12).
UNASSIGNED: The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.