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Analysis of Out-of-hospital Cardiac Arrest in A Pediatric Emergency Department: Report from A Regional Teaching Hospital
一兒童急診室到院前心跳停止之分析：一區域教學醫院之報告
摘要
背景及目的：到院前心肺功能停止並不常見於兒科急診部門，此研究主旨在分析某區域教學醫院之兒科急診部門，到院前心跳停止兒童的存活率，病因，及流行病學。方法：研究對象收集自在過去7年的時間內於仁愛醫院兒科急診部門，其兒童年齡小於18歲者且抵達醫院前即已呈心肺功能停止狀態做為研究對象，病童資料的收集則是來自在急診部門和辦理住院到病房後的醫療紀錄。結果：在所有的30位病童中, 由平均年齡為6.8歲（最小年齡為15天大新生兒，最大年齡為17歲，中位數5歲；15位男孩，15位女孩）所組成。有22位病童是非創傷性的個案，4位病童是創傷性和4位病童是溺水，10位（33%）非創傷性的個案中，其年齡在1-12個月大，又其中的9位是導因於突發嬰幼兒猝死症候群，季節的變化則呈現出多數事件的發生在春季和冬季。有7位（23%）在事件發生的最初即因成功的心肺復甦術並恢復自發性的循環狀態，隨後入住緊急加護單位中；又當中僅有3位病童是在醫院中存活下來並得以出院，而這3位病童皆有神經學上的缺失。結論：非創傷性到院前心肺功能停止的病童比起因創傷而到院前死亡的病童有較高的存活率。18歲以下病人到院前心肺功能停止之存活率在我們研究中的比率是10%；及有30%的到院前心跳停止是導因於突發的嬰幼兒猝死症候群。在我們的研究中也發現到到院前心肺功能停止的情形在一月份至三月有較高的發生率。
並列摘要
Background and purpose: Cases of out-of-hospital cardiac arrest (OHCA) are uncommon in pediatric emergency departments. This study aimed to analyze the survival rate, etiology, and epidemiology of OHCA in a pediatric emergency department.Methods: Children (＜18 years) who presented with OHCA at the pediatric emergency department of Jen-Ai Hospital over a 7-year period were enrolled in this study. Patient information was collected from medical charts at the emergency department (ED) and after admission to the ward.Results: A total of 30 patients (average age, 5 years; range, 15 days-17 years; 15 boys, 15 girls) were enrolled. Causes of OHCA were nontraumatic, traumatic, and drowning in 22, 4, and 4 cases, respectively. Ten patients with nontraumatic OHCA were aged 1-12 months, nine of whom had sudden infant death syndrome (SIDS). Successful initial cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC) was achieved in seven patients (23%), who were subsequently admitted to the intensive care unit (ICU). However, only three survived to hospital discharge, all with neurological defects.Conclusions: The overall survival rate of children with OHCA in our study was 10%. Children with nontraumatic OHCA had a higher survival rate than those with traumatic OHCA. In 30% patients, OHCA was caused by SIDS. The incidence of OHCA was higher between January and March.
延伸閱讀
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