Association between Hospital volume of cardiopulmonary resuscitation for in-hospital cardiac arrest and survival to Hospital discharge
Association between Hospital volume of cardiopulmonary resuscitation for in-hospital cardiac arrest and survival to Hospital discharge
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DOI：
10.1016/j.resuscitation.2019.12.037
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发表时间：
2020-03-01
期刊：
影响因子：
6.5
通讯作者：
Briasoulis, Alexandros
中科院分区：
文献类型：
--
作者：
Akintoye, Emmanuel;Adegbala, Oluwole;Briasoulis, Alexandros
背景：先前的研究表明，医院的病例数量与院外心脏骤停（OHCA）患者的生存率无关。然而，如何在医院心脏骤停（IHCA）的生存情况的影响是未知的：方法：我们查询了2005年至2011年在美国的国家住院病人样本（NIS），以确定在医院心肺复苏术进行IHCA的情况。限制立方脊柱被用来评估医院每年的CPR量和生存率之间的关联discharity.Results：在超过1000家医院在NIS，我们确定了125,082例（平均年龄67，45%女性）的IHCA的CPR是在研究期间进行。中位[Q1，Q3]病例量为60 [34，99]。与病例量的第一个四分位数相比，第四个四分位数的医院往往有更年轻的患者（平均值= 66 vs 68岁），更高的合并症（中位数Elixhauser评分= 4 vs 3），以及低收入地区（37 vs 30%）。总体而言，23%的患者存活至出院。心肺复苏量与生存率之间存在非线性关系：随着年度心肺复苏量的增加，观察到生存率提高的非显著趋势，在每年51-55例病例时达到稳定水平，此后生存率开始下降，并在每年75例病例后显着降低（p为非线性
Background: Prior studies have shown that hospital case volume is not associated with survival in patients with out-of-hospital cardiac arrest (OHCA). However, how case volume impact on survival for in-hospital cardiac arrest (IHCA) is unknown.Methods: We queried the National Inpatient Sample (NIS) in the U.S. 2005 2011 to identify cases in which in-hospital CPR was performed for IHCA. Restricted cubic spine was used to evaluate the association between hospital annual CPR volume and survival to hospital discharge.Results: Across more than 1000 hospitals in NIS, we identified 125,082 cases (mean age 67, 45% female) of IHCA for which CPR was performed over the study period. Median [Q1, Q3] case volume was 60 [34, 99]. Compared to those in the 1st quartile of case volume, hospitals in the 4th quartile tends to have younger patients (mean = 66 vs 68 yrs), higher comorbidities (median Elixhauser score = 4 vs 3), and in low income areas (37 vs 30%). Overall, 23% of the patients survived to hospital discharge. There was a non-linear association between CPR volume and survival: a non-significant trend towards better survival was observed with increasing annual CPR volume that reached a plateau at 51-55 cases per year, after which survival began to drop and became significantly lower after 75 cases per year (p for non-linearity