院内心搏骤停后行有创气道建立时间与复苏结局。
Time to invasive airway placement and resuscitation outcomes after inhospital cardiopulmonary arrest.
机构信息
UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA.
出版信息
Resuscitation. 2010 Feb;81(2):182-6. doi: 10.1016/j.resuscitation.2009.10.027.
BACKGROUND
Clinicians often place high priority on invasive airway placement during cardiopulmonary resuscitation. The benefit of early vs. later invasive airway placement remains unknown. In this study we examined the association between time to invasive airway (TTIA) placement and patient outcomes after inhospital cardiopulmonary arrest (CPA).
METHODS
We analyzed data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). We included hospitalized adult patients receiving attempted invasive airway placement (endotracheal intubation, laryngeal mask airway, tracheostomy, and cricothyrotomy) after the onset of CPA. We excluded cases in which airway insertion was attempted after return of spontaneous circulation (ROSC). We defined TTIA as the elapsed time from CPA recognition to accomplishment of an invasive airway. The primary outcomes were ROSC, 24-h survival, and survival to hospital discharge. We used multivariable logistic regression to evaluate the association between the patient outcome and early (<5 min) vs. later (> or =5 min) TTIA, adjusted for hospital location, patient age and gender, first documented pulseless ECG rhythm, precipitating etiology and witnessed arrest.
RESULTS
Of 82,649 CPA events, we studied the 25,006 cases in which TTIA was recorded and the inclusion criteria were met. Observations were most commonly excluded for not having an invasive airway emergently placed during resuscitation. The mean time to invasive airway placement was 5.9 min (95% CI: 5.8-6.0). Patient outcomes were: ROSC 50.3% (49.7-51.0%), 24-h survival 33.7% (33.1-34.3%), survival to discharge 15.3% (14.9-15.8%). Early TTIA was not associated with ROSC (adjusted OR: 0.96, 0.91-1.01) but was associated with better odds of 24-h survival (adjusted OR: 0.94, 0.89-0.99). The relationships between TTIA and survival to discharge could not be determined.
CONCLUSIONS
Early invasive airway insertion was not associated with ROSC but was associated with slightly improved 24-h survival. Early invasive airway management may or may not improve inhospital cardiopulmonary resuscitation outcomes.
背景
临床医生在心肺复苏期间通常高度重视有创气道的建立。早期与晚期有创气道建立的益处尚不清楚。在这项研究中，我们研究了院内心搏骤停（CPA）后有创气道（TTIA）放置时间与患者结局之间的关系。
方法
我们分析了国家心肺复苏登记处（NRCPR）的数据。我们纳入了接受有创气道（气管插管、喉罩气道、气管切开术和环甲膜切开术）尝试的住院成年患者，这些患者在 CPA 发生后进行。我们排除了在自主循环恢复（ROSC）后尝试气道插入的病例。我们将 TTIA 定义为从 CPA 识别到完成有创气道的时间间隔。主要结局是 ROSC、24 小时生存率和出院生存率。我们使用多变量逻辑回归评估患者结局与早期（<5 分钟）与晚期（≥5 分钟）TTIA 之间的关联，调整了医院位置、患者年龄和性别、首次记录的无脉心电图节律、诱发病因和目击性骤停。
结果
在 82649 例 CPA 事件中，我们研究了 25006 例记录 TTIA 且符合纳入标准的病例。最常见的排除原因是复苏期间未紧急放置有创气道。有创气道放置的平均时间为 5.9 分钟（95%CI：5.8-6.0）。患者结局为：ROSC 50.3%（49.7-51.0%）、24 小时生存率 33.7%（33.1-34.3%）、出院生存率 15.3%（14.9-15.8%）。早期 TTIA 与 ROSC 无关（调整后的 OR：0.96，0.91-1.01），但与 24 小时生存率的几率更高相关（调整后的 OR：0.94，0.89-0.99）。TTIA 与出院生存率之间的关系尚无法确定。
结论
早期有创气道插入与 ROSC 无关，但与 24 小时生存率略有提高相关。早期有创气道管理可能会或可能不会改善院内心肺复苏的结局。
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