日本全国脑心血管中心Yoshio Tahara课题组近日取得一项新成果。他们分析了日本院外心脏骤停患者公共电除颤和神经结局的关系。该项研究成果发表在2019年12月17日出版的《柳叶刀》上。

对于院外心脏骤停（OHCA）和可电击心律的患者，在紧急医疗服务（EMS）人员到达之前，超过80%的公共电除颤尝试并不会导致自发循环的持续性恢复。关于这些患者的神经状态和生存结果尚未评估。

研究组对日本2005年1月1日至2015年12月31日期间发生OHCA事件的1299784名患者进行了一项前瞻性、全国性、基于人群的队列研究的回顾性分析。

研究组确定了28019名患者，他们发生OHCA时有目击者，均为可电击心律，且接受了目击者进行的心肺复苏（CPR）。2242例（8.0%）患者接受CPR和公共电除颤后自发循环未恢复，25087名（89.5%）患者仅接受CPR，在EMS到来之前自发循环未恢复。

接受公共电除颤的患者神经功能恢复良好率为37.7%，显著高于未接受公共电除颤的患者（22.6%）。接受公共电除颤的患者OHCA后30天的存活率为44.0%，显著高于未接受公共电除颤的患者（31.8%）。

研究结果支持公共电除颤的益处，以及社区自动除颤器的易接近性和可用性。

附：英文原文

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

Author: Takahiro Nakashima, Teruo Noguchi, Yoshio Tahara, Kunihiro Nishimura, Satoshi Yasuda, Daisuke Onozuka, Taku Iwami, Naohiro Yonemoto, Ken Nagao, Hiroshi Nonogi, Takanori Ikeda, Naoki Sato, Hiroyuki Tsutsui

Issue&Volume: December 17, 2019

Abstract: 

Background

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.

Methods

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.

Findings

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).

Interpretation

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

DOI: 10.1016/S0140-6736(19)32488-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32488-2/fulltext