Sandroni Claudio, Nolan Jerry, Cavallaro Fabio, Antonelli Massimo
Intensive Care Unit, Catholic University School of Medicine, Rome, Italy.
Intensive Care Med. 2007 Feb;33(2):237-45. doi: 10.1007/s00134-006-0326-z. Epub 2006 Sep 22.
Review.
Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival.
The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
综述。
对关于院内心脏骤停（IHCA）的医学文献进行综述，以总结：（a）IHCA的发生率及复苏后生存率；（b）主要预后因素；（c）可能改善生存率的干预措施。
文献中很少报道IHCA的发生率。其值介于每1000例住院患者中有1至5例事件，或每年每床位0.175例事件。报道的出院生存率从0%至42%不等，最常见的范围是15%至20%。心脏骤停前的预后因素：年龄的预后价值存在争议。在合并症中，脓毒症、癌症、肾衰竭和居家生活方式与生存率低显著相关。然而，心脏骤停前的发病评分尚未作为预测IHCA后生存失败的工具得到前瞻性验证。心脏骤停期间的因素：首次记录的心律为室颤/室性心动过速（VF/VT）以及IHCA与心肺复苏或除颤之间的间隔较短与较高的生存率相关。然而，仅25%至35%的IHCA患者出现VF/VT。胸部按压频率高于80次/分钟进行复苏的患者短期生存率也较高。可能改善生存率的干预措施包括：对有IHCA风险的患者进行早期识别和稳定以实现预防、在医院内更快更好地进行复苏以及早期除颤。轻度治疗性低温对因VF/VT导致的院外心脏骤停进行骤停后治疗有效，但其在IHCA后以及非VF/VT心律的心脏骤停后的益处尚未得到明确证实。
