Sandroni Claudio, Ferro Giorgia, Santangelo Susanna, Tortora Francesca, Mistura Lorenza, Cavallaro Fabio, Caricato Anselmo, Antonelli Massimo
Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Gemelli 8, 00168 Rome, Italy.
Resuscitation. 2004 Sep;62(3):291-7. doi: 10.1016/j.resuscitation.2004.03.020.
To evaluate the factors affecting the outcome of in-hospital cardiac arrest.
A 1400-bed tertiary care teaching hospital with a dedicated cardiac arrest team (CAT). The CAT was immediately available in monitored areas (intensive care unit and emergency room). In the wards the staff had only BLS skills and automated external defibrillation was not available.
A 2-year prospective audit according to the Utstein style.
A total of 114 cardiac arrests (37 with VF/VT and 77 with non-VF/VT) were included. Fifty-two cardiac arrests (46%) occurred in monitored areas, 62 (54%) occurred in non-monitored areas. The CAT arrival time in non-monitored areas was 3.98+/-1.73 min. Thirty-seven patients (32%) survived to hospital discharge. Cardiac arrests occurring in monitored areas had a significantly better outcome than those occurring in the wards. Patient survival in the wards was significantly higher when the CAT arrival time was less than 3 min. No patient whose CAT arrival time was longer than 6 min survived. CAT arrival time was significantly shorter (1.30+/-1.70) in survivors than in non-survivors (2.51+/-2.37; P<0.005). Sex, age and presence of bystanders were not significantly associated with survival.
In our setting, where bystander defibrillation was not available, the survival of patients having cardiac arrest in non-monitored areas strongly depends on advanced life support provided by the CAT. A faster CAT response and early defibrillation from the ward staff are the most important improvements necessary to increase cardiac arrest survival in our setting.
评估影响院内心脏骤停结局的因素。
一家拥有1400张床位的三级护理教学医院，设有专门的心脏骤停团队（CAT）。在监测区域（重症监护病房和急诊室），CAT可随时待命。在病房，工作人员仅具备基础生命支持技能，且没有自动体外除颤器。
按照Utstein模式进行为期2年的前瞻性审计。
共纳入114例心脏骤停患者（37例为室颤/室速，77例为非室颤/室速）。52例心脏骤停（46%）发生在监测区域，62例（54%）发生在非监测区域。CAT到达非监测区域的时间为3.98±1.73分钟。37例患者（32%）存活至出院。发生在监测区域的心脏骤停结局明显优于病房内的。当CAT到达时间少于3分钟时，病房内患者的存活率显著更高。CAT到达时间超过6分钟的患者无一存活。存活者的CAT到达时间（1.30±1.70）明显短于非存活者（2.51±2.37；P<0.005）。性别、年龄和旁观者在场情况与存活率无显著相关性。
在我们的环境中，由于没有旁观者除颤，非监测区域发生心脏骤停患者的存活很大程度上依赖于CAT提供的高级生命支持。更快的CAT响应和病房工作人员的早期除颤是提高我们环境中心脏骤停存活率所需的最重要改进措施。
