Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults
Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults
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DOI：
10.1001/jama.282.24.2333
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发表时间：
1999-12-22
影响因子：
120.7
通讯作者：
Phillips, RS
中科院分区：
文献类型：
--
作者：
Goodlin, SJ;Zhong, ZS;Phillips, RS
背景流行病学的不复苏（DNR）命令住院患者已被报道，但鲜为人知的因素与使用心肺复苏（CPR.Objective），以确定相关的因素与尝试心肺复苏的患者谁经历了cardiopulmonaryarrest.Design二次分析的数据收集在2个前瞻性队列研究：了解预后和治疗结果及风险偏好的研究（支助，1989-1994年）和住院老年人纵向项目（救命，一九九四年）地点美国五所教学医院。参与者共有2505名80岁或以上的重症住院患者和非选择性住院患者，他们经历了心肺功能衰竭。主要结果测量CPR努力，DNR订单，疾病的严重程度，年龄，种族，性别，住院时间和生存的医疗记录数据;功能状态和偏好，通过与患者或代理人的访谈获得的CPR;和2个月的生存率估计提供的physics.Results五百十四研究对象（21%）在他们的索引住院期间接受CPR。其中，327例（63.6%）在死亡后2天内进行了心肺复苏，93例（18.1%）进行了复苏并在指数住院期间存活。男性更可能使用心肺复苏术（比值比[OR]，1.39; 95%置信区间[CI]，1.12-1.73），年轻患者（每10年增加的OR，0.90; 95% CI，0.84-0.96），非裔美国人（OR，1.76; 95% CI，1.33-2.34），报告首选CPR的患者（OR，2.60; 95%CI，1.91-3.55），报告生活质量更好（OR，1.49; 95%CI，1.10-2.03），或医生对2个月生存期的估计更高（OR每增加10%，1.14; 95%CI，1.09-1.19）。率变化显着的地理位置和诊断;充血性心力衰竭患者的调整OR为3.31（95%CI，2.12-5.15）相比，急性呼吸衰竭或多器官系统failure. Conclusions患者，我们的数据表明，复苏的尝试是更有可能时，首选的患者和死亡是最少的预期。需要进一步的研究来了解不同地点之间以及不同诊断、种族、性别或年龄的患者使用CPR的差异。
Context The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR).Objective To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest.Design Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994).Setting Five teaching hospitals across the United States.Participants A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest.Main Outcome Measures Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians.Results Five hundred fourteen study subjects (21%) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1%) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60; 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure.Conclusions Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race,sex, or age.