加拿大圣保罗医院Jim Christenson团队研究了院外心脏骤停患者停搏转运和持续现场复苏与存活出院的相关性。2020年9月15日，该研究发表在《美国医学会杂志》上。

在院外心脏骤停（OHCA）复苏过程中，急诊医疗系统（EMS）运送存在较大差异，严重影响患者预后。与持续现场复苏相比，在停搏期间强行转运的益处尚不明确。

为了确定在发生OHCA的患者中，进行停搏转运与现场持续复苏相比是否影响出院生存率，2011年4月至2015年6月，研究组在美国10个急诊中心进行了一项前瞻性队列研究，招募接受EMS治疗的非创伤性成人OHCA患者，随访至患者出院或死亡。

整个队列包括43969名患者，中位年龄为67岁，其中37%为女性，86%的心脏骤停发生在私人场所，49％有目击者或EMS见证，22%接受初始电击复律，97%接受了院外高级生命支持治疗，26%接受了停搏内转运。

停搏转运的患者出院生存率为3.8%，接受现场复苏的患者为12.6%。倾向匹配的队列包括27705名患者，接受停搏转运的患者出院生存率为4.0％，而接受现场复苏的患者则为8.5％，差异显著。接受停搏转运的患者中有2.9％神经系统预后良好，接受现场复苏的患者则为7.1％，差异显著。初始电击复律和非电击复律亚组，以及EMS见证和非见证的心脏骤停亚组中，停搏转运患者的出院生存率均显著降低。

总之，对于OHCA患者，与持续现场复苏相比，在停搏期间将其送往医院与患者出院生存率较低显著相关。

附：英文原文

Title: Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest

Author: Brian Grunau, Noah Kime, Brian Leroux, Thomas Rea, Gerald Van Belle, James J. Menegazzi, Peter J. Kudenchuk, Christian Vaillancourt, Laurie J. Morrison, Jonathan Elmer, Dana M. Zive, Nancy M. Le, Michael Austin, Neal J. Richmond, Heather Herren, Jim Christenson

Issue&Volume: 2020/09/15

Abstract:

Importance  There is wide variability among emergency medical systems (EMS) with respect to transport to hospital during out-of-hospital cardiac arrest (OHCA) resuscitative efforts. The benefit of intra-arrest transport during resuscitation compared with continued on-scene resuscitation is unclear.

Objective  To determine whether intra-arrest transport compared with continued on-scene resuscitation is associated with survival to hospital discharge among patients experiencing OHCA.

Design, Setting, and Participants  Cohort study of prospectively collected consecutive nontraumatic adult EMS-treated OHCA data from the Resuscitation Outcomes Consortium (ROC) Cardiac Epidemiologic Registry (enrollment, April 2011-June 2015 from 10 North American sites; follow-up until the date of hospital discharge or death [regardless of when either event occurred]). Patients treated with intra-arrest transport (exposed) were matched with patients in refractory arrest (at risk of intra-arrest transport) at that same time (unexposed), using a time-dependent propensity score. Subgroups categorized by initial cardiac rhythm and EMS-witnessed cardiac arrests were analyzed.

Exposures  Intra-arrest transport (transport initiated prior to return of spontaneous circulation), compared with continued on-scene resuscitation.

Main Outcomes and Measures  The primary outcome was survival to hospital discharge, and the secondary outcome was survival with favorable neurological outcome (modified Rankin scale <3) at hospital discharge.

Results  The full cohort included 43969 patients with a median age of 67 years (interquartile range, 55-80), 37% were women, 86% of cardiac arrests occurred in a private location, 49% were bystander- or EMS-witnessed, 22% had initial shockable rhythms, 97% were treated by out-of-hospital advanced life support, and 26% underwent intra-arrest transport. Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation. In the propensity-matched cohort, which included 27705 patients, survival to hospital discharge occurred in 4.0% of patients who underwent intra-arrest transport vs 8.5% who received on-scene resuscitation (risk difference, 4.6% [95% CI, 4.0%- 5.1%]). Favorable neurological outcome occurred in 2.9% of patients who underwent intra-arrest transport vs 7.1% who received on-scene resuscitation (risk difference, 4.2% [95% CI, 3.5%-4.9%]). Subgroups of initial shockable and nonshockable rhythms as well as EMS-witnessed and unwitnessed cardiac arrests all had a significant association between intra-arrest transport and lower probability of survival to hospital discharge.

Conclusions and Relevance  Among patients experiencing out-of-hospital cardiac arrest, intra-arrest transport to hospital compared with continued on-scene resuscitation was associated with lower probability of survival to hospital discharge. Study findings are limited by potential confounding due to observational design.

DOI: 10.1001/jama.2020.14185

Source: https://jamanetwork.com/journals/jama/article-abstract/2770622