Introduction

Precipitating aetiology of out-of-hospital cardiac arrest (OHCA), as confirmed by diagnostic testing or autopsy, provides important insights into burden of OHCA and has potential implications for improving OHCA survivorship. This study aimed to describe the aetiology of non-traumatic resuscitated OHCAs treated at hospital within a local health network according to available documentation, and to investigate differences in outcome between aetiologies.

Methods

Observational retrospective cohort study of consecutive OHCA treated at hospital within a local health network between 2011–2016. Cases without sustained ROSC (≥20 minutes), unverified cardiac arrest, and retrievals to external acute care facilities were excluded. A single aetiology was determined from the hospital medical record and available autopsy results. Survival to hospital discharge was compared between adjudicated aetiologies.

Results

In the 314 included cases, distribution of precipitating aetiology was 53% cardiac, 18% respiratory, 3% neurological, 6% toxicological, 9% other, and 11% unknown. A presumed cardiac pre-hospital diagnosis was assigned in 235 (84%) cases, 20% of which were incorrect after exclusion of unknown cases. Rates of survival to hospital discharge varied significantly across aetiologies: cardiac 64%, respiratory 21%, neurological 0%, toxicological 58%, other 32% (p < 0.001). A two-fold difference in survival was observed between cardiac and non-cardiac aetiologies (64% versus 29%, excluding unknown, p < 0.001).

Conclusions

Non-cardiac aetiologies represented a substantial burden of resuscitated OHCA treated at hospital within a local health network and were associated with poor outcome. The results confirmed that true aetiology was not evident on initial examination in 1 in 5 cases with a pre-hospital cardiac diagnosis.

中文翻译：

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在医院治疗的院外心脏骤停复苏的病因

介绍

正如诊断测试或尸检所证实的那样，院外心脏骤停 (OHCA) 的诱因提供了对 OHCA 负担的重要见解，并对提高 OHCA 存活率具有潜在意义。本研究旨在根据可用文件描述在当地卫生网络内的医院治疗的非创伤性复苏 OHCA 的病因，并调查病因之间的结果差异。

方法

2011 年至 2016 年期间在当地卫生网络内的医院接受连续 OHCA 治疗的观察性回顾性队列研究。排除了没有持续 ROSC（≥20 分钟）、未经证实的心脏骤停和转至外部急症护理机构的病例。根据医院病历和可用的尸检结果确定了单一病因。在判定的病因之间比较存活到出院的情况。

结果

在纳入的 314 例病例中，诱发病因的分布为 53% 心脏，18% 呼吸，3% 神经，6% 毒理学，9% 其他，11% 未知。235 例 (84%) 病例进行了假定的心脏院前诊断，其中 20% 在排除未知病例后不正确。不同病因的出院生存率差异很大：心脏 64%、呼吸 21%、神经 0%、毒理学 58%、其他 32% (p < 0.001)。在心脏和非心脏病因之间观察到两倍的存活率差异（64% 对 29%，不包括未知因素，p < 0.001）。

结论

非心脏病因代表了在当地卫生网络内的医院接受复苏的 OHCA 的巨大负担，并且与不良结果相关。结果证实，在院前心脏诊断的 5 例病例中，有 1 例在初始检查中没有明显的真正病因。