目的:表现为无脉性电活动(PEA)的心脏骤停(SCA)的比例显着增加,生存率仍然低于心室纤颤(VF)。然而,与未存活者相比,PEA-SCA病例亚组确实存活,并且可能产生改善结局的关键预测因子.我们旨在从PEA-SCA中确定生存的关键预测因子。
方法:我们的研究样本来自两个正在进行的社区,院外SCA的前瞻性研究:来自波特兰的俄勒冈州SUDS,或都会区(流行。大约。100万;2002-2017)和文图拉县的文图拉·普雷托,CA(流行音乐。大约。85万,2015-2021年)。对于当前的子研究,我们纳入了以PEA作为表现节奏的SCA病例,急诊医疗服务(EMS)人员尝试复苏.
结果:我们确定了1,704例PEA-SCA病例,其中173人(10.2%)为幸存者,1,531人(89.8%)为非幸存者。PEA-SCA发生在医疗机构(16.9%)或公共场所(18.1%)的患者生存率高于PEA-SCA发生在家庭(9.3%)或医疗机构(5.7%)的患者。年轻的年龄,证人身份,PEA-SCA位置和预先存在的COPD/哮喘是生存的独立预测因子。在目击病例中,即使EMS反应时间>10分钟,生存率也为10%。
结论:PEA-SCA生存的关键决定因素是年轻,见证地位,公共场所和预先存在的COPD/哮喘。目击PEA病例的生存结果好于预期,即使EMS响应延迟。
The proportion of sudden cardiac arrests (SCA) manifesting with pulseless electrical activity (PEA) has increased significantly, and the survival rate remains lower than ventricular fibrillation (VF). However, a subgroup of PEA-SCA cases does survive and may yield key predictors of improved outcomes when compared to non-survivors. We aimed to identify key predictors of survival from PEA-SCA.
Our study sample is drawn from two ongoing community-based, prospective studies of out-of-hospital SCA: Oregon SUDS from the Portland, OR metro area (Pop. approx. 1 million; 2002-2017) and Ventura PRESTO from Ventura County, CA (Pop. approx. 850,000, 2015-2021). For the present sub-study, we included SCA cases with PEA as the presenting rhythm where emergency medical services (EMS) personnel attempted resuscitation.
We identified 1,704 PEA-SCA cases, of which 173 (10.2%) were survivors and 1,531 (89.8%) non-survivors. Patients whose PEA-SCA occurred in a healthcare unit (16.9%) or public location (18.1%) had higher survival than those whose PEA-SCA occurred at home (9.3%) or in a care facility (5.7%). Young age, witness status, PEA-SCA location and pre-existing COPD/asthma were independent predictors of survival. Among witnessed cases the survival rate was 10% even if EMS response time was >10 minutes.
Key determinants for survival from PEA-SCA were young age, witnessed status, public location and pre-existing COPD/asthma. Survival outcomes in witnessed PEA cases were better than expected, even with delayed EMS response.