In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge.
In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge.
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DOI：
10.1161/circoutcomes.121.008420
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Girotra S
中科院分区：
文献类型：
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作者：
Chan PS;Spertus JA;Kennedy K;Nallamothu BK;Starks MA;Girotra S
关于受新型冠状病毒疾病严重影响的医院复苏护理挑战的最新报告2019 2019冠状病毒病（COVID-19）大流行引发了关于大流行如何影响整个美国住院心脏骤停（IHCA）结局的问题。在“遵循指南-复苏”范围内，我们进行了一项回顾性队列研究，以比较在激增前（1月1日至2月29日），激增（3月1日至5月15日）和2020年激增后（5月16日至6月30日）时期与2015-2019年相比。每个医院所在县的每月COVID-19死亡率按每100万居民分为低（0-10）、中等（11-50）、高（51-100）或非常高（>100）。使用分层回归模型，我们比较了2020年与2015-2019年每个时期的生存率。在61，586起IHCA中，21，208起（2020年为4309起）、26，459起（2020年为5949起）和13，919起（2020年为2686起）分别发生在激增前、激增和激增后时期。在前激增期间，2020年有24.2%的患者存活出院，而2015-2019年为24.7%（调整后OR，1.12 [95%CI：1.02-1.22]）。相比之下，在激增期间，2020年有19.6%的患者存活出院，而2015-2019年为26.0%（调整后OR，0.81 [0.75-0.88]）。较低的生存率在每月COVID-19死亡率高（生存率降低28%）和非常高（生存率降低42%）的社区中最为明显（相互作用P值<0.001）。复苏时间较短（中位数：22 vs. 25分钟; P<0.001），延迟肾上腺素治疗更普遍（11.3% vs. 9.9%; P=0.004）。即使从分析中排除确诊/疑似COVID-19感染的患者，生存率也较低。在后激增期间，2020年与2015-2019年的生存率相似（22.3%与25.8%;调整后OR，0.93 [0.83-1.04]），包括COVID-19死亡率高的社区（交互P值=0.16）。疫情初期，即使在未感染COVID-19的患者中，IHCA的出院存活率也有所下降，凸显了COVID-19疫情对院内复苏的早期影响。
Recent reports on challenges in resuscitation care at hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic raise questions about how the pandemic affected outcomes for in-hospital cardiac arrest (IHCA) throughout the U.S. Within Get-With-The-Guidelines-Resuscitation, we conducted a retrospective cohort study to compare IHCA survival during the pre-surge (January 1-February 29), surge (March 1-May 15) and immediate post-surge (May 16-June 30) periods in 2020 compared to 2015–2019. Monthly COVID-19 mortality rates for each hospital’s county were categorized, per 1,000,000 residents, as low (0–10), moderate (11–50), high (51–100), or very high (>100). Using hierarchical regression models, we compared rates of survival to discharge in 2020 vs. 2015–2019 for each period. Of 61,586 IHCAs, 21,208 (4309 in 2020), 26,459 (5949 in 2020), and 13,919 (2686 in 2020) occurred in the pre-surge, surge, and post-surge periods, respectively. During the pre-surge period, 24.2% survived to discharge in 2020 vs. 24.7% in 2015–2019 (adjusted OR, 1.12 [95% CI: 1.02–1.22]). In contrast, during the surge period, 19.6% survived to discharge in 2020 vs. 26.0% in 2015–2019 (adjusted OR, 0.81 [0.75–0.88]). Lower survival was most pronounced in communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates (interaction P-value<0.001). Resuscitation times were shorter (median: 22 vs. 25 minutes; P<0.001) and delayed epinephrine treatment was more prevalent (11.3% vs. 9.9%; P=0.004) during the surge period. Survival was lower even when patients with confirmed/suspected COVID-19 infection were excluded from analyses. During the post-surge period, survival rates were similar in 2020 vs. 2015–2019 (22.3% vs. 25.8%; adjusted OR, 0.93 [0.83–1.04]), including communities with high COVID-19 mortality (interaction P-value=0.16). Early during the pandemic, rates of survival to discharge for IHCA decreased, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.