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心脏骤停后入住英国重症监护病房的预后:ICNARC病例组合项目数据库的二次分析

Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database.

作者信息

Nolan J P, Laver S R, Welch C A, Harrison D A, Gupta V, Rowan K

机构信息

Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG, UK.

出版信息

Anaesthesia. 2007 Dec;62(12):1207-16. doi: 10.1111/j.1365-2044.2007.05232.x.

Abstract

Using a retrospective analysis of the Intensive Care National Audit and Research Centre Case Mix Programme Database (ICNARC CMPD), we have summarised the characteristics and outcomes for mechanically ventilated patients admitted to UK intensive care units (ICUs) after cardiac arrest. Descriptive statistics on case mix, physiology, treatment, service delivery, outcome and activity were described separately for community cardiac arrest, in-hospital cardiac arrest (peri-operative) and in-hospital cardiac arrest (not peri-operative). The impact on outcome of several patient characteristics and physiological values were analysed using multivariable logistic regression. Mechanically ventilated survivors of cardiac arrest accounted for 24,132 (5.8%) of all admissions to the 174 ICUs in the ICNARC CMP. Of these, 10,347 (42.9%) survived to leave the ICU and 6778 (28.6%) survived to acute hospital discharge. The ICNARC model gives much better discrimination than APACHE II for predicting hospital mortality after admission to ICU following cardiac arrest: the predicted hospital mortality based on the APACHE II and ICNARC model was 41.9% and 79.7%, respectively.

摘要

通过对重症监护国家审计与研究中心病例组合计划数据库(ICNARC CMPD)进行回顾性分析,我们总结了心脏骤停后入住英国重症监护病房(ICU)的机械通气患者的特征及转归情况。分别针对院外心脏骤停、院内心脏骤停(围手术期)和院内心脏骤停(非围手术期),描述了病例组合、生理学指标、治疗、服务提供、转归及活动方面的描述性统计数据。采用多变量逻辑回归分析了若干患者特征和生理学指标对转归的影响。心脏骤停后机械通气的幸存者占ICNARC CMP中174个ICU所有入院患者的24,132例(5.8%)。其中,10,347例(42.9%)存活至离开ICU,6778例(28.6%)存活至急性医院出院。在预测心脏骤停后入住ICU的患者的医院死亡率方面,ICNARC模型比APACHE II模型具有更好的辨别能力:基于APACHE II模型和ICNARC模型预测的医院死亡率分别为41.9%和79.7%。

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