Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study

被引：67

作者：

Izawa, Junichi ^{[1
,2
]}

Komukai, Sho ^{[3
]}

Gibo, Koichiro ^{[4
]}

Okubo, Masashi ^{[5
]}

Kiyohara, Kosuke ^{[6
]}

Nishiyama, Chika ^{[7
]}

Kiguchi, Takeyuki ^{[8
]}

Matsuyama, Tasuku ^{[9
]}

Kawamura, Takashi ^{[8
]}

Iwami, Taku ^{[8
]}

Callaway, Clifton W. ^{[5
]}

Kitamura, Tetsuhisa ^{[10
]}

机构：

[1] Jikei Univ, Dept Anesthesiol, Sch Med, Tokyo 1058491, Japan

[2] Univ Pittsburgh, Ctr Crit Care Nephrol, Dept Crit Care Med, Pittsburgh, PA 15260 USA

[3] Osaka Univ, Grad Sch Med, Div Biomed Stat, Dept Integrated Med, Osaka, Japan

[4] Okinawa Chubu Hosp, Dept Emergency Med, Uruma, Okinawa, Japan

[5] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA USA

[6] Otsuma Womens Univ, Dept Food Sci, Tokyo, Japan

[7] Kyoto Univ, Dept Crit Care Nursing, Grad Sch Human Hlth Sci, Kyoto, Japan

[8] Kyoto Univ, Hlth Serv, Kyoto, Japan

[9] Kyoto Prefectural Univ Med, Dept Emergency Med, Kyoto, Japan

[10] Osaka Univ, Grad Sch Med, Dept Social & Environm Med, Div Environm Med & Populat Sci, Osaka, Japan

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2019年 / 364卷

关键词：

EUROPEAN RESUSCITATION COUNCIL; PULSELESS ELECTRICAL-ACTIVITY; PUBLIC-ACCESS DEFIBRILLATION; AMERICAN-HEART-ASSOCIATION; CARDIOPULMONARY-RESUSCITATION; TRACHEAL INTUBATION; ENDOTRACHEAL INTUBATION; SURVIVAL; GUIDELINES; STRATEGY;

D O I：

10.1136/bmj.l430

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. DESIGN Cohort study between January 2014 and December 2016. SETTING Nationwide, population based registry in Japan (All-Japan Utstein Registry). PARTICIPANTS Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. MAIN OUTCOME MEASURES Survival at one month or at hospital discharge within one month. RESULTS Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). CONCLUSIONS In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.

引用

页数：11