院外心停止患者に対するコロナ禍での診療方針変更の転帰への影響(Impact of a change in treatment strategy on outcomes of out–of–hospital cardiac arrest patients during the COVID–19 pandemic)

要旨 【目的】2019年12月に発生した新型コロナウイルス感染症（COVID–19）の流行を機に変更した院外心停止患者に対する診療方針の変更が妥当であったか検討すること。【方法】COVID–19期とコロナ禍前の同様の期間をCOVID–19前期として両期間に山梨県立中央病院高度救命救急センター（以下，当センター）へ搬送された院外心停止患者を検討対象とし，後方視的に患者背景，治療内容，予後を比較検討した。【結果】COVID–19前期840例，COVID–19期993例の1,833例が検討対象となった。病院前診療はCOVID–19期で有意に減少した。消防の覚知から救急隊の現場到着までの時間は8分から9分，病院到着までの時間も37分から39分と有意に延長した。病院到着後の心拍再開率は33%から21%へと減少し，入院率も23%から13%へ減少した。生存退院は6%と5%，神経学的予後良好も4%と4%であり，両期間に有意差は認めなかった。【結語】当センターに搬送された院外心停止はコロナ禍では，救急隊の現場到着が遅延し病院到着までの時間も延長していた。病院前診療が減少し心拍再開率，入院率は減少したが，生存退院，神経学的予後良好の割合は同等を維持していた。当センターのCOVID–19期の蘇生中止基準は妥当だったと考える。 ABSTRACT Aims: To determine whether the change in treatment policy for out–of–hospital cardiac arrest patients, which was changed in response to the December 2019 outbreak of the coronavirus disease 2019 (COVID–19), was justified. Methods: Backgrounds, treatment details, and prognoses of patients with out–of–hospital cardiac arrest brought to the Advanced Emergency and Critical Care Medical Center of Yamanashi Prefectural Central Hospital (the Center) before and after the pandemic were compared retrospectively. Results: The study included 1,833 cases, comprising 840 and 993 cases in the pre–COVID–19 and COVID–19 periods, respectively. A significantly reduced number of patients were provided with prehospital emergency care in the COVID–19 period. The length of time between the emergency call and the arrival of an ambulance team at the site increased significantly from 8min to 9min, and the length of time between the emergency call and the arrival of the patient at the hospital also increased significantly from 37min to 39min. The rates of return of spontaneous circulation after arrival at the hospital decreased from 33% to 21%. There were no significant differences between the two periods in terms of survival to hospital discharge, i.e., 6% and 5% patients, and favorable neurological prognosis, i.e., 4% and 4% patients. Conclusion: In patients with out–of–hospital cardiac arrest brought to the Center, the lengths of time from the emergency call to ambulance team arrival at the site and patient arrival at the hospital increased during the COVID–19 pandemic. The rates of survival to hospital discharge and favorable neurological prognosis remained unchanged. We believe that our center's COVID–19 phase resuscitation termination criteria were reasonable.