Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA 23298-0401, USA.
Resuscitation. 2012 Jan;83(1):63-9. doi: 10.1016/j.resuscitation.2011.09.009. Epub 2011 Sep 29.
An estimated 350,000-750,000 adult, in-hospital cardiac arrest (IHCA) events occur annually in the United States. The impact of resuscitation system errors on survival during IHCA resuscitation has not been evaluated. The purpose of this paper was to evaluate the impact of resuscitation system errors on survival to hospital discharge after IHCA.
We evaluated subjective and objective errors in 118,387 consecutive, adult, index IHCA cases entered into the Get with the Guidelines National Registry of Cardiopulmonary Resuscitation database from January 1, 2000 through August 26, 2008. Cox regression analysis was used to determine the relationship between reported resuscitation system errors and other important clinical variables and the hazard ratio for death prior to hospital discharge. Of the 108,636 patients whose initial IHCA rhythm was recorded, resuscitation system errors were committed in 9,894/24,467 (40.4%) of those with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) and in 22,599/84,169 (26.8%) of those with non-VF/pVT. The most frequent system errors related to delay in medication administration (>5 min time from event recognition to first dose of a vasoconstrictor), defibrillation, airway management, and chest compression performance errors. The presence of documented resuscitation system errors on an IHCA event was associated with decreased rates of return of spontaneous circulation, survival to 24h, and survival to hospital discharge. The relative risk of death prior to hospital discharge based on hazard ratio analysis was 9.9% (95% CI 7.8, 12.0) more likely for patients whose initial documented rhythm was non-VF/pVT when resuscitation system errors were reported compared to when no errors were reported. It was 34.2% (95% CI 29.5, 39.1) more likely for those with VF/pVT.
The presence of resuscitation system errors that are evident from review of the resuscitation record is associated with decreased survival from IHCA in adults. Hospitals should target the training of first responders and code team personnel to emphasize the importance of early defibrillation, early use of vasoconstrictor medication, and compliance with ACLS protocols.
据估计，每年在美国有 35 万至 75 万例成人院内心搏骤停（IHCA）事件。复苏系统错误对 IHCA 复苏期间的生存影响尚未得到评估。本文旨在评估 IHCA 后复苏期间复苏系统错误对出院存活率的影响。
我们评估了 2000 年 1 月 1 日至 2008 年 8 月 26 日连续进入 Get with the Guidelines 国家心肺复苏注册数据库的 118387 例成人指数 IHCA 病例中的主观和客观错误。Cox 回归分析用于确定报告的复苏系统错误与其他重要临床变量之间的关系，并确定出院前死亡的危险比。在初始 IHCA 节律记录的 108636 例患者中，在初始节律为心室颤动或无脉性室性心动过速（VF/pVT）的 24467 例中有 9894 例（40.4%）和初始节律为非 VF/pVT 的 84169 例中有 22599 例（26.8%）发生了复苏系统错误。最常见的系统错误与药物给药延迟（从事件识别到首次使用血管收缩剂的时间超过 5 分钟）、除颤、气道管理和胸外按压性能错误有关。IHCA 事件中存在记录的复苏系统错误与自主循环恢复率、24 小时生存率和出院生存率降低相关。基于危险比分析，与未报告错误时相比，初始记录的节律为非 VF/pVT 且报告有复苏系统错误的患者出院前死亡的相对风险增加了 9.9%（95%CI7.8，12.0）；VF/pVT 患者的相对风险增加了 34.2%（95%CI29.5，39.1）。
从复苏记录审查中明显看出复苏系统错误的存在与成人 IHCA 存活率降低有关。医院应针对急救人员和编码小组成员的培训，强调早期除颤、早期使用血管收缩药物和遵守 ACLS 方案的重要性。
