■室颤(VF)或无脉性室性心动过速(pVT)是院外心脏骤停(OHCA)的最可治疗的原因。然而,它仍然是未知的,如果除颤垫的位置,放置在前后(AP)或前后(AL)位置,影响VF或pVTOHCA患者的预后。
■确定出现VF或pVT的患者的初始除颤器垫放置位置与OHCA结果之间的关联。
■这项前瞻性队列研究包括从2019年7月1日至2023年6月30日由北美急诊医疗服务(EMS)机构治疗的OHCA和VF或pVT患者。该研究包括由郊区大型消防EMS机构治疗的OHCA患者,该机构覆盖了550,000人。包括接受EMS除颤的初始EMS评估的VF或pVT节律的连续患者。儿科患者(18岁以下),设施间转移,逮捕明显的创伤性病因,并排除先前存在不复苏状态的患者.
■AP或AL焊盘放置。
■在任何时间恢复自发循环(ROSC),在急诊科(ED)到达时出现脉搏的次要结果,存活到入院,存活到出院,和出院时的功能生存率(脑表现类别评分为2分或更低)。措施包括调整后的赔率比(AOR),多变量Logistic回归,和精细灰色竞争风险回归。
■共纳入255例OHCA患者(中位[IQR]年龄,66[55-74]岁;63名女性[24.7%]),初始垫定位记录为AP(158例患者[62.0%];中位[IQR]年龄,65[54-74]岁;37名女性[23.4%])或AL(97名患者[38.0%];中位[IQR]年龄,66[57-74]岁;26名女性[26.8%])。AP患者在任何时候都有较高的ROSC调整比值比(aOR)(aOR,2.64[95%CI,1.50-4.65]),但在ED到达时脉搏出现的几率没有显著差异(1.34[95%CI,0.78-2.30]),生存至入院(1.41[0.82-2.43]),生存至出院(1.55[95%CI,0.83-2.90]),或出院时的功能生存率(1.86[95%CI,0.98-3.51])。竞争风险分析发现,与AL相比,在初始AP放置的风险人群中,ROSC的累积发生率明显更高(子分布风险比,1.81[95%CI,1.23-2.67];P=.003)。
■在这项OHCA和VF或pVT患者的队列研究中,与AL放置相比,AP除颤器垫放置与较高的ROSC相关。
UNASSIGNED: Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) locations, impacts patient outcomes in VF or pVT OHCA.
UNASSIGNED: To determine the association between initial defibrillator pad placement position and OHCA outcomes for patients presenting with VF or pVT.
UNASSIGNED: This prospective cohort study included patients with OHCA and VF or pVT treated by a single North American emergency medical services (EMS) agency from July 1, 2019, through June 30, 2023. The study included patients with OHCA treated by a large suburban fire-based EMS agency that covers a population of 550 000. Consecutive patients with an initial EMS-assessed rhythm of VF or pVT receiving EMS defibrillation were included. Pediatric patients (younger than 18 years), interfacility transfers, arrests of obvious traumatic etiology, and patients with preexisting do-not-resuscitate status were excluded.
UNASSIGNED: AP or AL pad placement.
UNASSIGNED: Return of spontaneous circulation (ROSC) at any time with secondary outcomes of pulses present at emergency department (ED) arrival, survival to hospital admission, survival to hospital discharge, and functional survival at hospital discharge (cerebral performance category score of 2 or less). Measures included adjusted odds ratios (aOR), multivariable logistic regressions, and Fine-Gray competing risks regression.
UNASSIGNED: A total of 255 patients with OHCA were included (median [IQR] age, 66 [55-74] years; 63 females [24.7%]), with initial pad positioning documented as either AP (158 patients [62.0%]; median [IQR] age, 65 [54-74] years; 37 females [23.4%]) or AL (97 patients [38.0%]; median [IQR] age, 66 [57-74] years; 26 females [26.8%]). Patients with AP placement had higher adjusted odds ratio (aOR) of ROSC at any time (aOR, 2.64 [95% CI, 1.50-4.65]), but not significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission (1.41 [0.82-2.43]), survival to hospital discharge (1.55 [95% CI, 0.83-2.90]), or functional survival at hospital discharge (1.86 [95% CI, 0.98-3.51]). Competing risk analysis found significantly greater cumulative incidence of ROSC among those at risk with initial AP placement compared with AL (subdistribution hazard ratio, 1.81 [95% CI, 1.23-2.67]; P = .003).
UNASSIGNED: In this cohort study of patients with OHCA and VF or pVT, AP defibrillator pad placement was associated with higher ROSC compared with AL placement.