| Summary: | 博士 === 國防醫學院 === 醫學科學研究所 === 106 === Background: In 2010, American Heart Association has recommended that modified chain of survival is necessary for patients with cardiac arrest. Based on event locations, cardiac arrest could be classified into the out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Cardiac diseases and trauma were the most common origins of cardiac arrest. However, prognosis of post cardiac arrest for hospitalized patients remains unclear after implementiaon of modified chain of survival in Taiwan.
Aims: To investigate the survival outcomes and compare the difference before and after implementiaon of modified chain of survival in Taiwan.
Indicators: Main outcome was to estimate the proportion of survival to discharge. Secondary outcomes were to examine the chance of 2-day, 7-day, and 30-day survivals.
Material and methods: We conducted this retrospective study by using information from the National Health Insurance Research Database (NHIRD) for the period from 2007 to 2013. We found diagnosis of using International Classification of Diseases, Ninth Revision, Clinical Modification to define study subjects (ventricular fibrillation「427.41」 or cardiac arrest「427.5」). Information on characteristics of patient, hospital, event were extractred from the claims data, including age, sex, comorbidities, hospital level, geographic area, teaching status, intensive care unit beds, total beds, cardiac rhythm on admission, location, transfer to another hospital, calendar year and types of injury. Multiple logistic regression would constructed to examine the association between factors of interests and outcomes by using SPSS 22.0 for Windows (IBM, Armonk, NY). For all data analyses, we deemed a P value of less than 0.05 to be significant, and all tests were two sided.
Results: A total of 35,187 cases were selected from the NHIRD. Rate of survival to discharge was 26.7%. There were 12,540 patients of hospitalized OHCA and 22,647 events of hospitalized IHCA; percentages of survival to discharge were 22.1% and 29.4% respectively. Results noted that discharge rate of hospitalized traumatic cardiac arrest (TCA) was 27.1%, and 43.7% for those due to coronary artery disesase (CAD). After implementiaon of modified chain of survival, adjusted odds ratio (aOR) [95% confidence interval (CI)] with 2-day survival was 1.07 (1.02-1.12) for all subjects, 1.11 (1.03-1.20) for hospitalized OHCA, 1.17 (1.02-1.35) for hospitalized TCA, and 1.16 (1.03-1.29) for hospitlazed victims due to CAD. Among hospitalized OHCA, there was 17% increment of 7-day survival chance. The aOR (95% CI) was 1.12 (1.01-1.24) for survival to discharge of hospitalized ones due to CAD. For hospitalized TCA, different types of injury associated with survival to discharge were identified; the aOR (95% CI) was 1.81 (1.16-2.80) for poisoning, 1.37 (1.00-1.88) for falls and 1.86 (1.37-1.88) for drowning/suffocation compared with traffic accidents.
Conclusions: Excpet for hospitalized IHCA, there was significant improvement of short-term survival condition after implementiaon of modified chain of survival. Meanwhile, proportion of survival to discharge was obviously elevated during the period among hospitalized patients due to CAD.
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