到院前心臟休止病患送往心臟休止中心與轉送時間對神經學預後的影響性

Abstract

背景 本研究主要在分析到院前心臟休止病患於合理的轉送時間下，直接送往心臟休止中心是否有較好的預後。 方法 收集6875名由資料庫於2012/01-2016/12桃園市由緊急醫療救護員轉送的心臟休止病患。病患藉由初始體外電擊器心律去分層，而去分析轉送時間與心臟休止中心的存活及神經學預後。 結果 6875 名中有5222 名（76%）為不可電擊心律及1653 名可電擊心律。不可電擊心律的族群中有3106 名直接送往心臟休止中心，而可電擊心律則為1076 名。平均轉送時間明顯較長於送往心臟休止中心。可電擊心律的病患送往心臟休止中心有較高可能的存活(< 8 分鐘: OR 1.98,95% CI 1.40–2.79)及神經學預後(< 8 分鐘: OR 2.36, 95% CI 1.52–3.66; ≥ 8 分鐘: OR 2.01, 95%CI 1.13–3.59). 結論 可電擊心律的院前心臟休止病患直接送往心臟休止中心可能有較好機率的神經學預後。而不可電擊心律的病患則應該送往就近醫院。

Background: This study was undertaken to determine whether all OHCA patients treated in CACs had better outcomes and if the transport time to CACs matter. Methods: Data from 6875 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City between January 2012 and December 2016 were collected. Patients were stratified by the initial rhythm. The relation between the transport time to CACs and survival to discharge and good neurological outcome were investigated. Results: Of the 6875 patients, 5222 (76.0%) were presented with non-shockable rhythms and 1653 (24.0%) with shockable rhythms. There were 3106 (59.5%) and 1076 (65.9%) patients with non-shockable and shockable rhythms, respectively, transported to CACs. The mean transport time to CACs was significantly longer than that to non-CACs (p=0.044). Solely in patients with shockable rhythms was transported to CACs increased the likelihood of survival to discharge (< 8 minutes: OR:1.98, 95% CI 1.40–2.79) and good neurological outcome (< 8 minutes: OR 2.36, 95% CI 1.52–3.66;≥ 8 minutes: OR 2.01, 95% CI 1.13–3.59). Conclusions: Adult OHCA patients with shockable rhythms transported to CACs had higher probabilities of surviving to discharge and good neurological outcome than their counterparts. Direct ambulance delivery to CACs should be considered particularly when the OHCA patients are presented with shockable rhythms.