Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest

作者：Rosell Ortiz Fernando; Garcia del Aguila Javier; Fernandez del Vallee Patricia; Mellado-Vergel Francisco J.; Vergara-Perez Santiago; Ruiz-Montero Maria R.; Martinez-Lara Manuela; Gomez-Jimenez Francisco J.; Gonzaez-Lobato Ismael; Garcia-Escudero Guillermo; Ruiz-Bailen Manuel; Caballero-Garcia Auxiliadora; Vivar-Diaz Ltziar; Olavarria-Govantes Luis

来源：Emergencias, 2018, 30(3): 156-162.

• Out-of-hospital cardiac arrest
• Ambulance cardiopulmonary resuscitation
• Emergency health services
• Futile cardiopulmonary resuscitation

Objective. To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport.
Methods. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome.
Results. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome.
Conclusions. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

• 出版日期2018-6