Donoghue Aaron, Berg Robert A, Hazinski Mary Fran, Praestgaard Amy H, Roberts Kathryn, Nadkarni Vinay M
Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Pediatrics. 2009 Dec;124(6):1541-8. doi: 10.1542/peds.2009-0727. Epub 2009 Nov 16.
The objective of this study was to assess whether pediatric inpatients who receive cardiopulmonary resuscitation (CPR) for bradycardia with poor perfusion are more likely to survive to hospital discharge than pediatric inpatients who receive CPR for pulseless arrest (asystole/pulseless electrical activity [PEA]), after controlling for confounding characteristics.
A prospective cohort from the National Registry of Cardiopulmonary Resuscitation was enrolled between January 4, 2000, and February 23, 2008. Patients who were younger than 18 years and had an in-hospital event that required chest compressions for >2 minutes were eligible. Patients were divided into 2 groups on the basis of initial rhythm and pulse state: bradycardia/poor perfusion and asystole/PEA. Patient characteristics, event characteristics, and clinical characteristics were analyzed as possible confounders. Univariate analysis between bradycardia and asystole/PEA patient groups was performed. Multivariable logistic regression was used to determine whether an initial state of bradycardia/poor perfusion was independently associated with survival to discharge.
A total of 6288 patients who were younger than 18 years were reported; 3342 met all inclusion criteria. A total of 1853 (55%) patients received chest compressions for bradycardia/poor perfusion compared with 1489 (45%) for asystole/PEA. Overall, 755 (40.7%) of 1353 patients with bradycardia survived to hospital discharge, compared with 365 (24.5%) of 1489 patients with asystole/PEA. After controlling for known confounders, CPR for bradycardia with poor perfusion was associated with increased survival to hospital discharge.
Pediatric inpatients with chest compressions initiated for bradycardia and poor perfusion before onset of pulselessness were more likely to survive to discharge than pediatric inpatients with chest compressions initiated for asystole or PEA.
本研究的目的是评估在控制混杂因素后，因灌注不良性心动过缓接受心肺复苏（CPR）的儿科住院患者与因心脏停搏（心脏停搏/无脉电活动[PEA]）接受CPR的儿科住院患者相比，是否更有可能存活至出院。
纳入了2000年1月4日至2008年2月23日期间来自国家心肺复苏登记处的前瞻性队列。年龄小于18岁且在医院发生需要胸外按压超过2分钟事件的患者符合入选标准。根据初始心律和脉搏状态将患者分为两组：心动过缓/灌注不良组和心脏停搏/PEA组。分析患者特征、事件特征和临床特征作为可能的混杂因素。对心动过缓组和心脏停搏/PEA组患者进行单因素分析。采用多变量逻辑回归确定心动过缓/灌注不良的初始状态是否与出院存活独立相关。
共报告了6288例年龄小于18岁的患者；3342例符合所有纳入标准。共有1853例（55%）患者因心动过缓/灌注不良接受胸外按压，而因心脏停搏/PEA接受胸外按压的患者有1489例（45%）。总体而言，1353例心动过缓患者中有755例（40.7%）存活至出院，而1489例心脏停搏/PEA患者中有365例（24.5%）存活至出院。在控制已知混杂因素后，因灌注不良性心动过缓进行的CPR与出院存活率增加相关。
在出现无脉之前因心动过缓和灌注不良而开始进行胸外按压的儿科住院患者比因心脏停搏或PEA而开始进行胸外按压的儿科住院患者更有可能存活至出院。
