院外心脏骤停STEMI和震荡性心律患者快速转运至心脏骤停中心——英国心血管干预学会转运算法的可行性试点研究

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE Resuscitation Pub Date : 2025-02-01 Epub Date: 2025-01-04 DOI:10.1016/j.resuscitation.2025.110491

Rupert F.G. Simpson , Thomas Johnson , Paul Rees , Guy Glover , Uzma Sajjad , Samer Fawaz , Sarosh Khan , Emma Beadle , Daryl Perilla , Maria Maccaroni , Christopher Cook , Marco Mion , Qiang Xue , Rohan Jagathesan , Gerald J. Clesham , Tom Quinn , Johannes Von Vopelius-Feldt , Sean Gallagher , Abdul Mozid , Ellie Gudde , Thomas R. Keeble

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引用次数: 0

摘要

背景和目的：指南建议将非创伤性院外心脏骤停（OHCA）转移到心脏骤停中心（CAC）。我们假设(a)基于OHCA后初始呈现节奏的院前转运算法是可行的，(b)将证明生存优势。方法：这项观察性先导研究纳入了2022年4月至2023年4月期间来自英国埃塞克斯郡的所有疑似心脏病因的OHCA患者。在前6个月，OHCA患者将运输作为标准护理。在接下来的6个月里，连续有STEMI或初始震荡性心律的OHCA患者被直接送到CAC，没有STEMI的初始非震荡性心律继续被送往最近的急诊科（BCIS协议）。主要结局是30天内因任何原因死亡。次要结局是生存和良好的神经预后。结果：330例患者（平均年龄67.5±13.1岁，男性66%）中，标准治疗组162例，BCIS转运组168例。算法的实施与较低的全因30天死亡率（81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10）和较高的30天生存率（神经预后良好）相关[15% vs 19%， RR 1.05 (0.95-1.15), p = 0.38]。事后分析显示，BCIS转运算法与初始休克节律患者的30天死亡率降低相关[(61%对41%，RR 1.5 (95% CI 1.05-2.13) p = 0.02]，以及MIRACLE2评分≤5的患者[(63%对38%，RR 0.59 (95% CI 0.61-0.86) p = 0.005]。结论：BCIS算法是可行的，不会影响总死亡率，但有信号表明，将初始具有震荡节律和低MIRACLE2评分的OHCA患者直接转移到专门的CAC可能会提高生存率。

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Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres − A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm

Background and aims

Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.

Methods

This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.

Results

Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98–1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95–1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05–2.13) p = 0.02 and in those with a MIRACLE₂ score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61–0.86) p = 0.005].

Conclusions

The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE₂ score, to a dedicated CAC may improve survival.

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来源期刊

Resuscitation 医学-急救医学

CiteScore

12.00

自引率

18.50%

发文量

556

审稿时长

21 days

期刊介绍： Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.