Continuous Improvements in “Chain of Survival” Increased Survival After Out-of-Hospital Cardiac Arrests

Author:

Iwami Taku1,Nichol Graham1,Hiraide Atsushi1,Hayashi Yasuyuki1,Nishiuchi Tatsuya1,Kajino Kentaro1,Morita Hiroshi1,Yukioka Hidekazu1,Ikeuchi Hisashi1,Sugimoto Hisashi1,Nonogi Hiroshi1,Kawamura Takashi1

Affiliation:

1. From Kyoto University Health Service (T.I.,T.K.), Kyoto, Japan; University of Washington–Harborview Center for Prehospital Emergency Care (G.N.), Seattle, Wash; Center for Medical Education (A.H.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Senri Critical Care Medical Center (Y.H.), Osaka Saiseikai Senri Hospital, Suita, Japan; Osaka Prefectural Senshu Critical Care Medical Center (T.N.), Izumisano, Japan; Emergency and Critical Care Medical Center (K.K.), Osaka Police Hospital,...

Abstract

Background— The impact of ongoing efforts to improve the “chain of survival” for out-of-hospital cardiac arrest (OHCA) is unclear. The objective of this study was to evaluate the incremental effect of changes in prehospital emergency care on survival after OHCA. Methods and Results— This prospective, population-based observational study involved consecutive patients with OHCA from May 1998 through December 2006. The primary outcome measure was 1-month survival with favorable neurological outcome. Multiple logistic regression analysis was used to assess factors that were potentially associated with better neurological outcome. Among 42 873 resuscitation-attempted adult OHCAs, 8782 bystander-witnessed arrests of presumed cardiac origin were analyzed. The median time interval from collapse to call for medical help, first cardiopulmonary resuscitation, and first shock shortened from 4 (interquartile range [IQR] 2 to 11) to 2 (IQR 1 to 5) minutes, from 9 (IQR 5 to 13) to 7 (IQR 3 to 11) minutes, and from 19 (IQR 13 to 22) to 9 (IQR 7 to 12) minutes, respectively. Neurologically intact 1-month survival after witnessed ventricular fibrillation increased from 6% (6/96) to 16% (49/297; P <0.001). Among all witnessed OHCAs, earlier cardiopulmonary resuscitation (odds ratio per minute 0.89, 95% confidence interval 0.85 to 0.93) and earlier intubation (odds ratio per minute 0.96, 95% confidence interval 0.94 to 0.99) were associated with better neurological outcome. For ventricular fibrillation, only earlier shock was associated with better outcome (odds ratio 0.84, 95% confidence interval 0.80 to 0.88). Conclusions— Data from a large, population-based cohort demonstrate a continuous increase in OHCA survival with improvement in the chain of survival. The incremental benefit of early advanced care on OHCA survival is also suggested.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference36 articles.

1. Part 1: Introduction

2. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/ncipc/wisqars. Accessed January 22 2008.

3. Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome

4. Temporal Trends in Sudden Cardiac Arrest

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3