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[Lancet发表论文]:日本公共使用除颤与院外心跳骤停患者神经系统预后:基于人口的队列研究
2020年01月09日 时讯速递, 进展交流 暂无评论

ARTICLES| VOLUME 394, ISSUE 10216, P2255-2262, DECEMBER 21, 2019

Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study

Takahiro Nakashima, Teruo Noguchi, Yoshio Tahara, et al

Lancet 2019; 394: 2255-2262

Background 背景

More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients.

对于发生院外心跳骤停 (OHCA) 且为可除颤心律的患者,在急救 (EMS) 人员抵达前使用公用除颤仪,超过80%的情况下未能使患者自主循环持续恢复。尚缺乏这些患者的神经系统预后及生存情况评价。我们旨在评估这些患者的神经系统状况及生存预后。

Methods 方法

This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918.

这是针对日本进行的前瞻性、全国性、基于人口的注册研究资料的回顾性分析,纳入2005年1月1日至2015年12月31日间发生OHCA事件的1299784名患者。主要预后终点为OHCA后30天神经系统预后良好 (脑功能分类 1 或 2),次要预后终点为OHCA后30天生存率。研究在 University Hospital Medical Information Network Clinical Trials Registry注册,注册号UMIN000009918。

Findings 结果

We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24–1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13–1·52], p<0·0001).

共有 28 019 名患者发生了路人目击OHCA且为可除颤心律,并接受了路人进行的CPR。 其中,2242 名 (8·0%) 患者尽管接受了CPR且使用了公用除颤仪,但未能恢复自主循环,25 087 名 (89·5%) 患者仅仅接受了CPR,在EMS抵达前未能恢复自主循环。使用公用除颤仪的患者神经系统预后良好的比例显著高于未使用者 (845 [37·7%] vs 5676 [22·6%]; 倾向性评分匹配后校正比数比 [OR], 1·45 [95% CI 1·24–1·69], p<0·0001)。使用公用除颤仪的患者OHCA后30天存活病例也显著高于未使用者 (987 [44·0%] vs 7976 [31·8%]; 倾向性评分匹配后校正 OR , 1·31 [95% CI 1·13–1·52], p<0·0001)。

Interpretation 结论

Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community.

我们的发现支持公用除颤仪存在益处,应当在社区增加自动体外除颤的设置。

Funding 资助

None.

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