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首页> 外文期刊>Prehospital emergency care >Intrastate Variation in Treatment and Outcomes of Out-of-Hospital Cardiac Arrest
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Intrastate Variation in Treatment and Outcomes of Out-of-Hospital Cardiac Arrest

机译：在医院外心脏骤停的治疗和结果的内部变异

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Objective: Our objective was to analyze and compare out-of-hospital cardiac arrest (OHCA) system of care performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan. We hypothesized that clinically and statistically significant variations in treatment and outcomes of OHCA exists within a single U.S. state. Methods: We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014-2015. Geocoding of the OHCA incident address was used to assign records to individual MCAs. MCA-based demographics, arrest characteristics, system of care performance and outcomes were quantified and compared. Associations between demographics, system of care parameters, and outcomes were examined at the MCA level. Results: A total of 8,115 records with complete data were available for analysis. Eleven MCAs met study inclusion criteria of 100 cases, producing a final sample size of 7,788 records (96%). Statistically significant variations in survival to hospital discharge ranged from 4.5% to 15% (p 0.001) (Adjusted odds ratio [AOR] range 0.6-2.0) and survival with good neurologic outcome 2.7-12.5% (p 0.001; AOR range 0.5-2.2,) were observed across MCAs. Bystander CPR ranged from 32% to 53% (p 0.001) and bystander AED application ranged from 3.5% 11.5% (p 0.05). Of patients admitted to the hospital alive, 29-68% received targeted temperature management. In hospital mortality ranged from 53.1% to 73.9% (p 0.05). Conclusion: Significant intrastate variability in OHCA system of care performance and outcomes currently exist and are similar to what has been previously reported across North America almost a decade ago. This degree of variability highlights the opportunity to optimize modifiable factors within local systems of care to improve OHCA outcomes.
机译：目的：我们的目标是分析和比较密歇根州的医疗控制权（MCA）水平的医院心脏逮捕（OHCA）护理表现和结果。我们假设OHCA的临床和统计学上显着变化存在于单一的U.S.状态。方法：从密歇根州的所有非创伤EMS处理的OHCA进行了回顾性，观察研究，从密歇根州的所有非创伤EMS治疗的OHCA进行了2014 - 2015年。 OHCA事件地址的地理编码用于将记录分配给单个MCA。基于MCA的人口统计学，逮捕特性，量化和结果进行了量化和比较。在MCA水平上检查人口统计学，护理参数和结果之间的关联。结果：共有8,115条带有完整数据的记录可供分析。 11 MCAS符合＆GT的研究纳入标准，生产最终样本量为7,788条记录（96％）。病人的病人对医院放电的统计学变化范围为4.5％至15％（P <0.001）（调节的差距率[AOR]范围为0.6-2.0），并具有良好的神经系统结果2.7-12.5％（P <0.001; AOR在MCAS上观察到0.5-2.2，）。旁观者CPR的范围为32％至53％（P <0.001），旁观者AED应用范围为3.5％11.5％（P <0.05）。患者入住医院的患者，29-68％受到目标温度管理。在医院死亡率范围为53.1％至73.9％（P <0.05）。结论：目前存在的OHCA护理绩效和结果的重要内容变异性，并且与此前几乎在北美遍布过十年前的内容。这种可变性程度突出了优化当地护理系统内的可修改因素的机会，以改善OHCA结果。

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