Predictors of early care withdrawal following out-of-hospital cardiac arrest
Predictors of early care withdrawal following out-of-hospital cardiac arrest
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DOI：
10.1016/j.resuscitation.2014.08.030
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发表时间：
2014-11-01
期刊：
影响因子：
6.5
通讯作者：
Eid, Shaker M.
中科院分区：
文献类型：
--
作者：
Albaeni, Aiham;Chandra-Strobos, Nisha;Eid, Shaker M.
目的：目的：探讨院外心脏骤停患者早期退出护理的相关因素。患者出院时按生存状态分类，死亡者分为退出治疗组和未退出治疗组。那些退出护理的人被进一步细分为早期护理退出，即72小时。多变量调整的比值比被用来评估与早期护理withdraw.Results：189例心脏骤停患者，只有36个先进的指令（19%）和99（52%）有护理撤回的因素。大多数患者的护理撤回在医院死亡（94/99，95%），其余的在临终关怀。早期退出治疗= 75岁，初始神经系统检查不佳，多种合并症，多器官衰竭，乳酸>= 10 mmol L-1，白人种族和无旁观者CPR。提前指令并没有出现，以确定早期护理withdraw.Conclusions：虽然大多数心脏骤停患者没有提前指令，护理往往撤回超过50%，并在许多接受的时间神经觉醒（72小时）之前。老年人、种族、合并症、多器官功能衰竭和最初的神经系统检查结果不佳等因素会影响患者是否放弃治疗，需要进一步研究以更好地了解这一现象以及其他指导此类决定的社会学因素。(C)2014爱思唯尔爱尔兰有限公司版权所有。
Aims: To identify factors that associated with early care withdrawal in out-of-hospital cardiac arrest patients.Methods: Data was collected from 189 survivors to hospital admission. Patients were classified by survival status upon hospital discharge, and those who died were categorized into withdrawal vs. no withdrawal of care. Those who had care withdrawn were further subdivided into early care withdrawal i.e. 72 h. Multivariable adjusted odds ratios were used to assess factors associated with early care withdrawal.Results: Of 189 patients with cardiac arrest, only 36 had advanced directives (19%) and 99 (52%) had care withdrawn. Most patients whose care was withdrawn died in hospital (94/99, 95%), and the remainder died in hospice. Care was withdrawn early = 75 years, poor initial neurologic exam, multiple co morbidities, multi-organ failure, lactic acid >= 10 mmol L-1, Caucasian race and absence of bystander CPR. Advance directives did not appear to determine early care withdrawal.Conclusions: Although most cardiac arrest patients do not have advance directives, care is often withdrawn in more than 50% and in many before the accepted time for neurological awakening (72 h). The decision to withdraw care is influenced by older age, race, preexisting co morbidities, multi-organ failure, and a poor initial neurological exam. Further studies are needed to better understand this phenomenon and other sociological factors that guide such decisions. (C) 2014 Elsevier Ireland Ltd. All rights reserved.