Survival After In-Hospital Cardiac Arrest in Critically Ill Patients Implications for COVID-19 Outbreak?
Survival After In-Hospital Cardiac Arrest in Critically Ill Patients Implications for COVID-19 Outbreak?
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DOI：
10.1161/circoutcomes.120.006837
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发表时间：
2020-07-01
影响因子：
6.9
通讯作者：
Nallamothu, Brahmajee K.
中科院分区：
文献类型：
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作者：
Girotra, Saket;Tang, Yuanyuan;Nallamothu, Brahmajee K.
循环血管质量结局。2020; 13：e006837. DOI：10.1161/CIRCOUTCOMES. 120.006837 2020年7月447例与更差的生存结局相关。在≥ 80岁的心搏停止或PEA机械通气患者中，总生存率为6%，CPC为1或2的生存率为3.7%。该组中CPC为1的生存率为1.7%。在所有同时接受血管加压药治疗的心搏停止或PEA患者中（n= 2845，队列的50%），在所有年龄组中，< 10%的患者出院时CPC为1或2，< 7%的患者出院时CPC为1。在≥ 80岁的心搏停止/PEA和使用血管加压药组中，CPC为1或2以及CPC为1的相应生存率分别为2.7%和1.2%。在室颤或无脉性室性心动过速患者中，尽管总体生存率高于心搏停止或PEA患者，但在年龄和血管加压药使用方面，生存率模式相似。在年龄< 50岁、有室颤或无脉性室性心动过速且未使用血管加压药的患者中，总生存率为26.1%，CPC为1或2的患者生存率为22.0%，CPC为1的患者生存率为16.5%。我们认为，这些数据可以帮助患者、提供者和医院领导者在COVID-19大流行的背景下讨论复苏政策和护理目标，这对美国医疗保健系统构成了前所未有的挑战。ICU病床、机械呼吸机和个人防护设备的供应有限，已经给卫生系统带来了巨大的压力。尽管如此，《华盛顿邮报》最近的一篇文章指出，一些医院已经在考虑对确诊的COVID-19患者实施普遍的不复苏令，这可能压倒了患者及其家属对复苏的愿望。2此外，《英国医学杂志》最近的一次讨论也强调了
Circ Cardiovasc Qual Outcomes. 2020; 13: e006837. DOI: 10.1161/CIRCOUTCOMES. 120.006837 July 2020 447 were associated with worse survival outcomes. In patients≥ 80 years old with asystole or PEA on mechanical ventilation, the overall rate of survival was 6%, and survival with CPC of 1 or 2 was 3.7%. Survival with CPC of 1 in that group was 1.7%. Among all patients with asystole or PEA who were also receiving vasopressors (n= 2845, 50% of the cohort),< 10% of patients were discharged with a CPC of 1 or 2 and< 7% were discharged with a CPC of 1, across all age groups. The corresponding rates of survival with a CPC of 1 or 2, and CPC of 1 were 2.7% and 1.2% in the≥ 80 years age group with asystole/PEA and on vasopressors. Similar patterns of survival by age and vasopressor use were noted in patients with ventricular fibrillation or pulseless ventricular tachycardia, although the overall rates were higher compared with patients with asystole or PEA. In patients< 50 years of age, with ventricular fibrillation or pulseless ventricular tachycardia who were not on vasopressors, overall survival was 26.1%, survival with a CPC of 1 or 2 was 22.0%, and survival with CPC of 1 was 16.5%. We think that these data can help inform discussions among patients, providers, and hospital leaders regarding resuscitation policies and goals of care in the context of the COVID-19 pandemic, which is posing unprecedented challenges to the US healthcare system. The limited supply of ICU beds, mechanical ventilators, and personal protective equipment is already placing a tremendous strain on health systems. That notwithstanding, a recent article in the Washington Post noted that some hospitals are already considering universal do-not-resuscitation orders in patients with confirmed COVID-19 potentially overriding wishes of patients and their families for resuscitation. 2 Furthermore, a recent discussion in the BMJ highlighted similar challenges in