急诊医疗服务治疗患者的院前氧疗与死亡率：一项前瞻性观察性多中心研究
Prehospital oxygen-therapy and mortality in patients treated by emergency medical services: a prospective, observational multicenter study.
作者信息
Del Pozo Vegas Carlos, Sanz-García Ancor, Dueñas-Ruiz Antonio, de Santos Castro Pedro, Gil Contreras Ana, Blanco González María, Correas Galán Alberto, B Soriano Joan, López-Izquierdo Raúl, Martín-Rodríguez Francisco
机构信息
1Faculty of Medicine, University of Valladolid, Valladolid 47003, Spain.
2Emergency Department, University Clinical Hospital, Castile and León Regional Health Authority, Valladolid 47003, Spain.
出版信息
World J Emerg Med. 2025 Jul 1;16(4):357-366. doi: 10.5847/wjem.j.1920-8642.2025.084.
BACKGROUND
Oxygen supply is a common procedure performed by emergency medical services (EMS); however, whether prehospital oxygen or fraction of inspired oxygen (FiO) therapy predict mortality has not been studied to date. This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.
METHODS
This was a prospective, observational, cohort, multicenter, EMS-delivery, ambulance-based study. Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces. Epidemiological variables, on-scene vital signs, and prehospital blood analysis data were collected. The primary outcome was short- (2-, 7-, and 30-day), medium- (90- and 180-day), and long-term (365-day) all-cause cumulative mortality. The samples were a priori split according to thresholds of their received FiO(FiO=0.21, that is without oxygen therapy; FiO between 0.22 and 0.49; and FiO≥0.5). The categorical variables FiO, epidemiological variables, vital signs, prehospital point-of-care testing (POCT) and patient outcomes were fitted with a logistic regression model. Additionally, a propensity score matching and a survival analysis were used.
RESULTS
The final sample included 7,494 patients, 70.3% of whom did not receive oxygen therapy, 15% with a FiO between 0.22 and 0.49, and 14.7% with a FiO≥0.5. The 2-day mortality was 0.4%, 5.3%, and 22.9% respectively (<0.001). The 365-day mortality was 9.9%, 33.1%, and 50.5% respectively (<0.001). Finally, the FiO predictive capacities 2-,30-, and 365-day mortality were AUC=0.870 (95%: 0.840-0.899), 0.810 (95%: 0.784-0.837), 0.704 (95%: 0.679-0.728), respectively.
CONCLUSION
Prehospital oxygen therapy by thresholds of FiO was linked to death and allowed mortality prediction. This finding could provide an aid for EMS providers, allowing to assess more individualized patient risk.
背景
氧气供应是紧急医疗服务（EMS）执行的常见操作；然而，院前氧气或吸入氧分数（FiO）治疗是否能预测死亡率，迄今为止尚未得到研究。本研究旨在确定在接受院前护理的未选定急性病患者中，与氧气治疗相关的死亡率。
方法
这是一项前瞻性、观察性、队列、多中心、基于EMS运送的救护车研究。由EMS管理并被优先送往西班牙三个省份四家医院急诊科的未选定急性病成人患者。收集了流行病学变量、现场生命体征和院前血液分析数据。主要结局是短期（2天、7天和30天）、中期（90天和180天）和长期（365天）的全因累积死亡率。样本根据其接受的FiO阈值进行先验划分（FiO = 0.21，即未进行氧气治疗；FiO在0.22至0.49之间；FiO≥0.5）。将分类变量FiO、流行病学变量、生命体征、院前即时检验（POCT）和患者结局纳入逻辑回归模型。此外，还使用了倾向得分匹配和生存分析。
结果
最终样本包括7494名患者，其中70.3%未接受氧气治疗，15%的FiO在0.22至0.49之间，14.7%的FiO≥0.5。2天死亡率分别为0.4%、5.3%和22.9%（<0.001）。365天死亡率分别为9.9%、33.1%和50.5%（<0.001）。最后，FiO对2天、30天和365天死亡率的预测能力的曲线下面积（AUC）分别为0.870（95%：0.840 - 0.899）、0.810（95%：0.784 - 0.837）、0.704（95%：0.679 - 0.728）。
结论
根据FiO阈值进行的院前氧气治疗与死亡相关，并可进行死亡率预测。这一发现可为EMS提供者提供帮助，以便评估更个体化的患者风险。
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