Bridgeport Hospital and Yale University School of Medicine, Bridgeport, Connecticut 06610, USA.
Am J Respir Crit Care Med. 2010 Aug 15;182(4):501-6. doi: 10.1164/rccm.200910-1639OC. Epub 2010 Apr 22.
Studies examining survival outcomes after in-hospital cardiopulmonary arrest (CPA) among intensive care unit (ICU) patients requiring medications for hemodynamic support are limited.
To examine outcomes of ICU patients who received cardiopulmonary resusitation.
We identified 49,656 adult patients with a first CPA occurring in an ICU between January 1, 2000 and August 26, 2008 within the National Registry of Cardiopulmonary Resuscitation. Survival outcomes of patients requiring hemodynamic support immediately before CPA were compared with those of patients who did not receive hemodynamic support (pressors), using multivariable logistic regression analyses to adjust for differences in demographics and clinical characteristics. Pressor medications included epinephrine, norepinephrine, phenylephrine, dopamine, dobutamine, and vasopressin.
The overall rate of survival to hospital discharge was 15.9%. Patients taking pressors before CPA were less likely to survive to discharge (9.3 vs. 21.2%; P < 0.0001). After multivariable adjustment, patients taking pressors before pulseless CPA were 55% less likely to survive to discharge (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.42-0.48). Age equal to or greater than 65 years (adjusted OR, 0.77; 95% CI, 0.73-0.82), nonwhite race (adjusted OR, 0.58; 95% CI, 0.54-0.62), and mechanical ventilation (adjusted OR, 0.60; 95% CI, 0.56-0.63) were also variables that could be identified before CPA that were independently associated with lower survival. More than half of survivors were discharged to rehabilitation or extended care facilities. Only 3.9% of patients who had CPA despite pressors were discharged home from the hospital, as compared with 8.5% of patients with a CPA and not taking pressors (adjusted OR, 0.53; 95% CI, 0.49-0.59).
Although overall survival of ICU patients was 15.9%, patients requiring pressors and who experienced a CPA in an ICU were half as likely to survive to discharge and to be discharged home than patients not taking pressors. This study provides robust estimates of CPR outcomes of critically ill patients, and may assist clinicians to inform consent for this procedure.
在需要药物进行血流动力学支持的重症监护病房（ICU）患者中，关于院内心肺复苏（CPR）后生存结果的研究有限。
检查接受心肺复苏的 ICU 患者的结果。
我们在全国心肺复苏注册中心内确定了 2000 年 1 月 1 日至 2008 年 8 月 26 日期间首次 ICU 内发生的 49656 名成年患者的首次 CPRA。使用多变量逻辑回归分析，比较在发生 CPRA 前需要血流动力学支持的患者（升压药）与未接受血流动力学支持（升压药）的患者的生存结果，以调整人口统计学和临床特征的差异。升压药包括肾上腺素、去甲肾上腺素、苯肾上腺素、多巴胺、多巴酚丁胺和血管加压素。
总体出院生存率为 15.9%。在 CPRA 前使用升压药的患者出院生存率较低（9.3% vs. 21.2%；P < 0.0001）。经过多变量调整，无脉性 CPRA 前使用升压药的患者出院生存率降低 55%（调整后的优势比[OR]，0.45；95%置信区间[CI]，0.42-0.48）。年龄等于或大于 65 岁（调整后的 OR，0.77；95% CI，0.73-0.82）、非白人种族（调整后的 OR，0.58；95% CI，0.54-0.62）和机械通气（调整后的 OR，0.60；95% CI，0.56-0.63）也是可以在 CPRA 之前识别的独立与生存率降低相关的变量。超过一半的幸存者出院至康复或长期护理机构。与未接受升压药的 CPRA 患者相比，尽管接受升压药但仍发生 CPRA 的患者出院回家的比例仅为 3.9%（调整后的 OR，0.53；95% CI，0.49-0.59）。
尽管 ICU 患者的总体生存率为 15.9%，但需要升压药且在 ICU 中发生 CPRA 的患者的出院生存率和出院回家的可能性仅是未接受升压药的患者的一半。本研究提供了关于危重症患者 CPR 结果的可靠估计，并可能有助于临床医生为该程序提供知情同意。
