Inter-hospital variations in resuscitation processes and outcomes of out-of-hospital cardiac arrests in Singapore

T. Z. Tan, Y. Hao, A. Ho, N. Shahidah, S. Yap, Y. Ng, N. Doctor, B. Leong, H. N. Gan, D. Mao, M. Y. Chia, S. O. Cheah, M. Ong
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引用次数: 6

Abstract

Background: Variability in post-resuscitation care of out-of-hospital cardiac arrests (OHCA) contributes to differences in survival outcomes. Interventions of significance include targeted temperature management (TTM) and percutaneous coronary intervention (PCI). In this study, we sought to determine the magnitude and factors involved. Methods: From April 2010 to December 2014, all consecutive OHCAs presenting to hospitals across Singapore were considered for analysis. Primary outcome was survival to discharge or 30 days. Secondary outcomes included survival to admission, and neurological outcome (Glasgow-Pittsburgh Cognitive Performance Categories ≤2). The effects of hospital-based resuscitative interventions and admitting hospital on outcome were compared using Chi-squared tests and multivariate logistic regression models. Results: A total of 7,609 OHCA cases were included from six hospitals in Singapore. TTM and PCI usage varied significantly (P<0.001). Hospitals B, C, D had a lower survival to discharge or 30 days post-arrest [adjusted odds ratio (AOR) 0.392, 95% CI: 0.229–0.671, P=0.0006; AOR 0.499, 95% CI: 0.298–0.837, P=0.008; AOR 0.495, 95% CI: 0.304–0.805, P=0.005, respectively]. Hospitals B, D had lower survival to discharge with good neurological function (AOR 0.390, 95% CI: 0.206–0.738, P=0.004; AOR 0.443, 95% CI: 0.249–0.791, P=0.006 respectively). Hospitals B, C, D, E had lower survival to ED admission (AOR 0.582, 95% CI: 0.462–0.733, P<0.0001; AOR 0.600, 95% CI: 0.474–0.759, P<0.001; AOR 0.678, 95% CI: 0.542–0.847, P=0.0007; AOR 0.620, 95% CI: 0.494–0.777, P<0.0001 respectively). Both teaching status and bed number (≥1,000 beds) are associated with improved survival to discharge or 30 days (OR 1.488, P=0.007; OR 1.536, P=0.005). Conclusions: TTM and PCI usage, and OHCA outcomes vary between hospitals. This is associated with teaching status, bed number, and post-resuscitation care.
新加坡院外心脏骤停复苏过程和结果的院间差异
背景:院外心脏骤停(OHCA)复苏后护理的可变性导致了生存结果的差异。重要的干预措施包括靶向温度管理(TTM)和经皮冠状动脉介入治疗(PCI)。在这项研究中,我们试图确定所涉及的规模和因素。方法:从2010年4月到2014年12月,考虑所有连续出现在新加坡各地医院的OHCA进行分析。主要结果是存活至出院或30天。次要结果包括入院生存率和神经系统结果(格拉斯哥-匹兹堡认知表现类别≤2)。使用卡方检验和多变量逻辑回归模型比较医院复苏干预和入院对结果的影响。结果:共有7609例OHCA病例来自新加坡的六家医院。TTM和PCI的使用差异显著(P<0.001)。B、C、D医院出院或停药后30天的存活率较低[调整比值比(AOR)分别为0.392,95%CI:0.229-0.671,P=0.006;AOR分别为0.499,95%CI:0.298-0.837,P=0.008;AOR为0.495,95%CI:0.304-0.805,P=0.005]。在神经功能良好的情况下,B、D医院的出院生存率较低(AOR分别为0.390、95%CI:0.206–0.738,P=0.004;AOR分别是0.443、95%CI:0.249–0.791,P=0.006)。医院B、C、D、E的ED入院生存率较低(AOR分别为0.582,95%CI:0.462-0.733,P<0.001;AOR为0.600,95%CI=0.474-0.759,P<0.001,AOR为0.678,95%CI0.542-0.847,P=0.0007;AOR分别是0.620,95%CI0.494-0.77,P<0.001)。教学状况和床位数量(≥1000张床位)都与出院或30天生存率的提高有关(or 1.488,P=0.007;or 1.536,P=0.005)。结论:TTM和PCI的使用以及OHCA的结果因医院而异。这与教学状态、床位和复苏后护理有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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