Tibballs James, Kinney Sharon
Intensive Care Unit, Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, 3052 Australia.
Resuscitation. 2006 Dec;71(3):310-8. doi: 10.1016/j.resuscitation.2006.05.009. Epub 2006 Oct 27.
Few prospective studies of the incidence and outcome of paediatric in-hospital cardiopulmonary arrest have been reported to enable quality assurance comparisons within and between institutions.
All cardiac and respiratory arrests and their management over a 41-month period in children not subject to palliative treatment or to a 'do not resuscitate' order were recorded and analysed using the Utstein template.
Cardiac arrest occurred in a total of 111 of 104,780 admissions (1.06/1000) while respiratory arrest alone occurred in 36 (0.34/1000). Return of spontaneous circulation (ROSC) was achieved in 81 patients (73%) in cardiac arrest but only 40 (36%) were discharged from hospital and 38 (34%) survived for 1 year. The 1-year survival from respiratory arrest alone was 97%. Cardiac arrest was four times more common (89 versus 22) and approximately 90 times the incidence in the intensive care unit compared with wards but 1-year survival was similar (34% versus 36%). The initial heart rhythms were hypotensive-bradycardia in 73 (66%) with 38% survival; asystole in 17 (15%) with 12% survival; ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 10 (9%) with 40% survival; pulseless electrical activity (PEA) in 10 (9%) with 30% survival and SVT in 1 with survival. Secondary ventricular fibrillation occurred in 15 children given adrenaline (epinephrine) for treatment of asystole, hypotensive-bradycardia or PEA of whom 11 had received adrenaline in an initial dose of > 15 mcg/kg and 4 had < 15 mcg/kg (P = 0.0013). Eleven of 15 patients (73%) in secondary VF never achieved ROSC.
In-patient paediatric cardiac arrest has a mediocre outcome with a better outlook if the initial rhythm is hypotensive-bradycardia, VF or pulsatile VT. Doses of adrenaline greater than 15 mcg/kg given for non-shockable rhythms may cause secondary VF which has a worse outcome than primary VF.
很少有关于儿科住院期间心肺骤停发生率及转归的前瞻性研究报告，难以在机构内部及机构之间进行质量保证比较。
采用Utstein模板记录并分析了104780例未接受姑息治疗或“不要复苏”医嘱的儿童在41个月期间发生的所有心脏和呼吸骤停及其处理情况。
在104780例入院患儿中，共发生心脏骤停111例（1.06/1000），单纯呼吸骤停36例（0.34/1000）。心脏骤停患儿中81例（73%）实现自主循环恢复（ROSC），但仅40例（36%）出院，38例（34%）存活1年。单纯呼吸骤停患儿1年生存率为97%。与病房相比，心脏骤停在重症监护病房更为常见（89例对22例），发生率约为病房的90倍，但1年生存率相似（34%对36%）。初始心律为低血压性心动过缓的有73例（66%），生存率为38%；心搏停止17例（15%），生存率为12%；室颤（VF）或无脉性室性心动过速（VT）10例（9%），生存率为40%；无脉性电活动（PEA）10例（9%），生存率为30%；室上性心动过速1例并存活。15例因心搏停止、低血压性心动过缓或PEA接受肾上腺素治疗的儿童发生继发性室颤，其中11例初始剂量肾上腺素>15μg/kg，4例<15μg/kg（P = 0.0013）。继发性室颤的15例患者中有11例（73%）未实现ROSC。
儿科住院患者心脏骤停转归一般，若初始心律为低血压性心动过缓、VF或有脉搏的VT则预后较好。用于不可电击心律的肾上腺素剂量大于15μg/kg可能导致继发性室颤，其预后比原发性室颤更差。
