병원 전 심정지 환자를 대상으로 한 제세동 횟수와 생존율 및 신경학적 예후와의 연관성

Abstract

Background: Early defibrillation is the treatment of choice in out-of-hospital cardiac arrests (OHCA) with initial shockable rhythms. However, the relationship between the frequency of defibrillation and neurological outcome was not clear. In this study, the frequency of defibrillation and other factors related to neurological outcome were investigated. Methods: Records of 255 adult patients, who were admitted to the hospital after resuscitation from OHCA between November 2008 and March 2012, were retrospectively reviewed. 6 months after the return of spontaneous circulation, patients were divided into two groups based on the cerebral performance category (CPC) score for neurologic prognosis. The frequency of defibrillation during resuscitation and other variables were analyzed between the two groups. Results: In the study group, initial rhythm was divided into two groups, non shockable rhythm (200, 78.4%) and shockable rhythm (55, 21.6%). The frequency of 1－7 defibrillations was significantly associated with good neurological outcome (OR 3.05, 95% CI 1.328－6.850). In addition, shockable initial rhythm (OR 4.520, 95% CI 1.953－10.459), arrest caused cardiac origin (OR 2.945, 95% CI 1.334－6.500), time to BLS (OR 1.139, 95% CI 1.033－1.256) and lower APACHII score (OR 1.095, 95% CI 1.026－1.169), which were associated with good neurological outcomes, independently. Conclusions: In those patients who survived from OHCA, adequate defibrillation was important to improve the neurological outcome, whether the initial rhythm was shockable or not. Frequency of 1－7 times defibrillation was associated with good neurological outcome.