DEVELOPING STRATEGIES TO PREVENT INHOSPITAL CARDIAC-ARREST - ANALYZING RESPONSES OF PHYSICIANS AND NURSES IN THE HOURS BEFORE THE EVENT
DEVELOPING STRATEGIES TO PREVENT INHOSPITAL CARDIAC-ARREST - ANALYZING RESPONSES OF PHYSICIANS AND NURSES IN THE HOURS BEFORE THE EVENT
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DOI：
10.1097/00003246-199402000-00014
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发表时间：
1994-02-01
影响因子：
8.8
通讯作者：
MATHEW, J
中科院分区：
文献类型：
--
作者：
FRANKLIN, C;MATHEW, J
目的：要确定：a）在医院普通内科病房的患者中心脏骤停前的先兆体征和症状的频率; B）护士和医生对这些体征和症状的反应的任何特征模式;以及c）在病房中心脏骤停在从内科重症监护室（ICU）出院的患者中是否比在其他患者中更频繁地发生。设计：连续20个月内发生院内心脏骤停的患者的病例系列。设置：1,000张床位的城市公立医院的普通病房。病人：在此期间，共有21，505人接受医疗服务。在急诊室和ICU中发生心脏骤停的患者以及有不复苏命令的患者被排除在研究之外。干预措施：无。测量和主要结果：内科病房中共有150例心脏骤停（心脏骤停率：7.0/1，000名患者），住院死亡率为91%。在150例病例中，有99例在心脏骤停后6小时内由护士或医生记录患者病情恶化。共同的调查结果包括：a）护士未能通知医生患者精神状态的恶化; B）医生未能在呼吸窘迫的情况下获得或解释动脉血气测量结果;以及c）ICU分诊医生未能在将患者转移到ICU之前稳定患者的状况。前ICU患者（心脏骤停率：14.7/1000例患者）比其他患者（心脏骤停率：6.8/1000例患者）更容易发生心脏骤停（p = 0.004）。结论：心脏骤停在普通病房的医院通常是由先兆症状和体征。预防心脏骤停的策略应包括对护士和医生进行培训，重点是心肺稳定以及如何应对神经和呼吸恶化。还应特别注意已从ICU出院的患者，他们在ICU出院后发生心脏骤停的风险高于其他内科患者。
Objectives: To determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more frequently in patients discharged from the medical intensive care unit (ICU) than in other patients. Design: Case series of consecutive patients who had an inhospital cardiac arrest over a 20-month period. Setting: General medical wards of a 1,000-bed urban public hospital. Patients: There were 21,505 total admissions to the medical service in this period. Patients whose cardiac arrests occurred in the Emergency Room and ICU and patients with do-not-resuscitate orders were excluded from the study. Interventions: None. Measurements and Main Results: There were a total of 150 cardiac arrests on the medical wards (cardiac arrest rate: 7.0/1,000 patients) with a hospital mortality rate of 91%. In 99 of 150 cases, a nurse or physician documented deterioration in the patient's condition within 6 hrs of cardiac arrest. Common findings included: a) failure of the nurse to notify a physician of a deterioration in the patient's mental status; b) failure of the physician to obtain or interpret an arterial blood gas measurement in the setting of respiratory distress; and c) failure of the ICU triage physician to stabilize the patient's condition before transferring the patient to the ICU. Former ICU patients (cardiac arrest rate: 14.7/1,000 patients) were more likely to suffer cardiac arrest than other patients (cardiac arrest rate: 6.8/1,000 patients) (p = .004). Conclusions: Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms. Strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration. Special attention should also be devoted to patients who have been discharged from the ICU who are at greater risk for cardiac arrest after ICU discharge than are other medical patients.