Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
Emerg Med Australas. 2011 Oct;23(5):569-79. doi: 10.1111/j.1742-6723.2011.01450.x. Epub 2011 Jun 27.
To describe in-hospital resuscitation outcomes and factors associated with survival at Auckland City Hospital, New Zealand.
The Utstein template for in-hospital cardiac arrests was used. A retrospective audit of all cardiac arrests 2004-06 determined patient demographics, resuscitation time intervals, interventions, survival and neurological outcome at 12 months. Factors associated with survival to discharge were explored with logistic regression.
There were 3470 in-hospital deaths. Resuscitation was attempted in 415 patients (12%), with survival to discharge 27.2%. Survival was higher in first rhythm VT/VF (52.7% vs 13.1%, χ(2) = 75.3, P < 0.001), when the arrest was 'In-Hours' (41.4% vs 17%, χ(2) = 30.1, P < 0.001) and with younger age (mean [SD] for survivors 59.4 [7.1]vs 69.1 [14] for non-survivors). These associations were independent predictors of survival after multivariate logistic regression, with OR 6.2 (95% CI 3.6-10.5), 3.1 (95% CI 1.8-5.4) and 1.04 (95% CI 1.02-1.06), respectively (all P < 0.001). Other univariate predictors of survival; cardiac arrest team on site, monitored arrest and time to CPR were not significant after multivariate logistic regression. Time intervals to arrest interventions were short. Twelve month neurological outcome was good (CPC1 or 2) in 97.1% (95% CI 91.6-99.4) of survivors.
Survival from cardiac arrest in our hospital compared well to similar centres and good neurological outcome was higher than reported previously. Reduced survival during the 'After-Hours' period is cause for concern, and further research into the factors underlying this is required.
描述新西兰奥克兰市医院院内复苏的结果，并探讨与存活相关的因素。
采用乌斯丁院内心脏骤停模板。对 2004-06 年所有院内心脏骤停患者进行回顾性审核，确定患者人口统计学特征、复苏时间间隔、干预措施、存活情况以及 12 个月时的神经功能结局。采用逻辑回归分析探讨与出院时存活相关的因素。
共有 3470 例院内死亡患者。对 415 例（12%）患者进行了复苏，出院时存活率为 27.2%。首次节律为 VT/VF 时存活率更高（52.7% vs 13.1%，χ(2) = 75.3，P < 0.001），且在“上班时间”（41.4% vs 17%，χ(2) = 30.1，P < 0.001）和年龄较轻时（存活者的平均年龄[标准差]为 59.4 [7.1]，而非存活者为 69.1 [14]）。这些关联在多变量逻辑回归分析后是存活的独立预测因素，OR 分别为 6.2（95%CI 3.6-10.5）、3.1（95%CI 1.8-5.4）和 1.04（95%CI 1.02-1.06）（均 P < 0.001）。存活的其他单变量预测因素；现场的心脏骤停团队、监测性心脏骤停和 CPR 时间在多变量逻辑回归后均不显著。到干预措施的时间间隔很短。存活者 12 个月的神经功能结局良好（CPC1 或 2），占 97.1%（95%CI 91.6-99.4）。
与类似中心相比，我院心脏骤停患者的存活率较好，神经功能结局良好的比例高于以往报道。“下班后”期间存活率下降令人担忧，需要进一步研究导致这种情况的相关因素。
