背景:对于院外心脏骤停(OHCA),时间是至关重要的。虽然EMS响应时间(ERT)和OHCA结果之间的关系得到了很好的研究,需要对其他干预时间的影响进行更全面的评估,这对指导临床实践至关重要。
目的:评估更长的总住院前时间(TPT)ERT,提前生命支持反应时间(ART)和EMS心肺复苏时间(ECT)增加死亡率,不利的神经系统结果,和OHCA出院时的严重并发症。
方法:来自美国和加拿大的31,926个OHCAs在复苏结果联盟流行病学登记处进行了鉴定。12个调整模型用于分析院前时间(TPT,ERT,ART和ECT)和三个结果(医院死亡率,不利的神经系统结果,和存活的OHCA的严重并发症)。
结果:TPT每增加10分钟,死亡风险增加0.14倍(校正比值比[OR]=1.14,95%置信区间[CI]=1.10-1.17),神经系统不良结局增加0.13倍(OR=1.13,CI=1.08-1.18)。ERT每增加5分钟,患者死亡风险明显增加(OR=1.36,CI=1.26-1.47)。ART(OR=1.10,CI=1.06-1.15),和ECT(OR=1.46,CI=1.37-1.56)。神经系统不良结局与ERT和ECT相关,以及ERT和ART的严重并发症。
结论:院前时间延长,特别是ERT和ECT,与住院死亡率密切相关,不利的神经功能,OHCA出院时出现严重并发症。
BACKGROUND: For out-of-hospital cardiac arrests (OHCAs), time is of the essence. While the relationship between EMS response time (ERT) and OHCA outcomes is well studied, a more comprehensive assessment of the effects of other intervention time is needed, which is essential to guide clinical practice.
OBJECTIVE: Evaluating how a longer total pre-hospital time (TPT), ERT, advance life support response time (ART) and EMS cardiopulmonary resuscitation time (ECT) increase the mortality rates, unfavorable neurological outcomes, and severe complications at discharge of OHCAs.
METHODS: 31,926 OHCAs from the USA and Canada were identified in Resuscitation Outcomes Consortium Epidemiologic Registry. Twelve adjusted models were used to analyze the relationship between the prehospital time (TPT, ERT, ART and ECT) and three outcomes (in hospital mortality, unfavorable neurological outcomes, and severe complications for surviving OHCAs).
RESULTS: Every 10-min increase in TPT was associated with a 0.14-fold increase in the risk of death (adjusted odds ratio [OR] = 1.14, 95 % confidence interval [CI] = 1.10-1.17) and a 0.13-fold increase of adverse neurological outcomes (OR = 1.13, CI =1.08-1.18). The risk of patient mortality markedly increased with every 5 min increase in ERT (OR = 1.36, CI = 1.26-1.47), ART (OR =1.10, CI = 1.06-1.15), and ECT (OR = 1.46, CI = 1.37-1.56). Adverse neurological outcome was associated with ERT and ECT, and severe complications with ERT and ART.
CONCLUSIONS: Prolonged prehospital time, particularly ERT and ECT, are closely associated with in-hospital mortality, unfavorable neurological functions, and severe complications at discharge in OHCAs.