Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
Resuscitation. 2011 Oct;82(10):1314-7. doi: 10.1016/j.resuscitation.2011.05.030. Epub 2011 Jun 15.
The purpose of this study was to determine the prevalence of in-hospital hypotension in patients surviving to admission after resuscitation from out-of-hospital cardiac arrest and compare it to that of traditional Utstein factors in predicting in-hospital mortality.
Single-center retrospective cohort of adult patients surviving to hospital admission after resuscitation from out-of-hospital sudden death between January 1, 2006 and October 31, 2009. Study variables included Utstein template data: age, sex, initial rhythm, witnessed or nonwitnessed arrest, presence or absence of bystander CPR, location of arrest, response time (time of 9-1-1 dispatch to first vehicle arrival), and hypotension (systolic pressure<90 or mean arterial pressure<60) within 24h of ROSC. Univariate comparisons of categorical variables were performed and the Wilcoxon rank-sum test was used to compare continuous variables. Multivariable logistic regression was then performed after inclusion of Utstein variables.
73 patients met the inclusion criteria, and in-hospital mortality occurred in 54 (74%). On univariate analysis, in-hospital hypotension (OR=3.5, 95%CI 1.1-10.0, p=0.02), pre-hospital rhythm other than VF/VT (OR 4.3, 95%CI 1.4-13.3, p=0.008), and an unwitnessed arrest (OR=6.9, 95%CI 0.8-56.5, p=0.04), were significant predictors of in-hospital mortality. On multivariable analysis, in-hospital hypotension (OR=9.8, 95%CI 1.5, 63.0, p=0.02), pre-hospital rhythm other than VT/VF (OR=8.5, 95%CI 1.3-58.8, p=0.03), and lack of bystander CPR (OR=13.2, 95%CI 1.6-111, p=0.02) remained statistically significant predictors of in-hospital mortality.
In-hospital hypotension was predictive of mortality, as was a pre-hospital nonshockable rhythm and lack of bystander CPR. In contrast, traditional pre-hospital risk factors: age, gender, public location of arrest, response time, and witnessed arrest, were not predictive.
本研究旨在确定复苏后存活至入院的院内心律失常患者的院内低血压发生率，并将其与传统的乌斯泰因（Utstein）因素进行比较，以预测院内死亡率。
这是一项单中心回顾性队列研究，纳入了 2006 年 1 月 1 日至 2009 年 10 月 31 日复苏后存活至入院的院外心搏骤停成年患者。研究变量包括乌斯泰因模板数据：年龄、性别、初始节律、目击或非目击骤停、旁观者心肺复苏（CPR）的有无、骤停地点、反应时间（9-1-1 调度至第一辆急救车到达的时间）以及 ROSC 后 24 小时内的低血压（收缩压<90mmHg 或平均动脉压<60mmHg）。对分类变量进行单变量比较，采用 Wilcoxon 秩和检验比较连续变量。然后在纳入乌斯泰因变量后进行多变量逻辑回归。
73 例患者符合纳入标准，院内死亡 54 例（74%）。单因素分析显示，院内低血压（OR=3.5，95%CI 1.1-10.0，p=0.02）、院前节律非室颤/室速（OR=4.3，95%CI 1.4-13.3，p=0.008）和非目击骤停（OR=6.9，95%CI 0.8-56.5，p=0.04）是院内死亡率的显著预测因素。多变量分析显示，院内低血压（OR=9.8，95%CI 1.5，63.0，p=0.02）、院前节律非室颤/室速（OR=8.5，95%CI 1.3-58.8，p=0.03）和缺乏旁观者 CPR（OR=13.2，95%CI 1.6-111，p=0.02）仍然是院内死亡率的统计学显著预测因素。
院内低血压、院前非除颤性节律和缺乏旁观者 CPR 可预测死亡率，而传统的院前危险因素：年龄、性别、公共骤停地点、反应时间和目击骤停与死亡率无关。
