Rhythms and outcomes of adult in-hospital cardiac arrest
Rhythms and outcomes of adult in-hospital cardiac arrest
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DOI：
10.1097/ccm.0b013e3181b43282
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发表时间：
2010-01-01
影响因子：
8.8
通讯作者：
Berg, Robert A.
中科院分区：
文献类型：
--
作者：
Meaney, Peter A.;Nadkarni, Vinay M.;Berg, Robert A.
Objective.确定心脏骤停期间心电图节律与生存结果的关系。设计：前瞻性观察性研究。设置：国家心脏病复苏登记处的411家医院。患者：1999年4月至2005年7月期间共有51，919例无脉性心脏骤停的成年患者。测量和主要结果：收集的登记数据包括首次记录的心律、患者人口统计学、事件前数据、事件数据以及生存和神经学结局数据。在51，919例索引心脏骤停中，首次记录的无脉性心律为3810例（7%）室性心动过速（VT），8718例（17%）室颤（VF），19，262例（37%）无脉性电活动（PEA）和20，129例（39%）心搏停止。5154例（27%）患者发生了随后的VT/VF（即在PEA或心搏停止复苏期间发生的VT或VF），首次记录到PEA心律，4988例（25%）患者发生了心搏停止。首次记录的VF和VT患者的出院存活率无差异（各为37%，校正比值比[OR]为1.08; 95%置信区间[Cl]为0.95-1.23）。PEA后的出院生存率略高于心搏停止后的出院生存率（12% vs. 11%，校正OR 1.1; 95% CI 1.00-1.18），首次记录VT/VF后的出院生存率明显高于PEA/心搏停止后的出院生存率（校正OR 1.68; 95% CI 1.55-1.82）。与PEA/心搏停止伴随后VT/VF相比，PEA/心搏停止伴随后VT/VF后的出院存活率也更高（PEA无VT/VF vs有VT/VF的患者分别为14% vs. 7%;无VT/VF vs有VT/VF的患者分别为12% vs. 8%;校正OR 1.60; 95% CI，1.44-1.80）。当首次记录的心律是可电击的而不是不可电击的时，出院存活率更高，PEA后的存活率略高于心搏停止。与PEA/心搏停止无后续VT/VF相比，PEA/心搏停止伴后续VT/VF后的出院生存率较低。(Crit Care Med 2010; 38：101-108）
Objective. To determine the relationship of electrocardiographic rhythm during cardiac arrest with survival outcomes.Design: Prospective, observational study.Setting: Total of 411 hospitals in the National Registry of Cardiopulmonary Resuscitation.Patients: Total of 51,919 adult patients with pulseless cardiac arrests from April 1999 to July 2005.Measurements and Main Results: Registry data collected included first documented rhythm, patient demographics, pre-event data, event data, and survival and neurologic outcome data. Of 51,919 indexed cardiac arrests, first documented pulseless rhythm was ventricular tachycardia (VT) in 3810 (7%), ventricular fibrillation (VF) in 8718 (17%), pulseless electrical activity (PEA) in 19,262 (37%) and asystole 20,129 (39%). Subsequent VT/VF (that is, VT or VF occurring during resuscitation for PEA or asystole) occurred in 5154 (27%), with first documented rhythm of PEA and 4988 (25%) with asystole. Survival to hospital discharge rate was not different between those with first documented VF and VT (37% each, adjusted odds ratio [OR]) 1.08; 95% confidence interval [Cl] 0.95-1.23). Survival to hospital discharge was slightly more likely after PEA than asystole (12% vs. 11%, adjusted OR 1.1; 95% CI 1.00-1.18), Survival to discharge was substantially more likely after first documented VT/VF than PEA/asystole (adjusted OR 1.68; 95% CI 1.55-1.82). Survival to discharge was also more likely after PEA/asystole without subsequent VT/VF compared with PEA/asystole with subsequent VT/VF (14% vs. 7% for PEA without vs. with subsequent VT/VF; 12% vs. 8% for asystole without vs. with subsequent VT/VF; adjusted OR 1.60; 95% CI, 1.44-1.80).Conclusions: Survival to hospital discharge was substantially more likely when the first documented rhythm was shockable rather than nonshockable, and slightly more likely after PEA than asystole. Survival to hospital discharge was less likely following PEA/asystole with subsequent VT/VF compared to PEA/asystole without subsequent VT/VF. (Crit Care Med 2010; 38:101-108)