Emergency Services Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, United States.
Resuscitation. 2013 Jan;84(1):31-6. doi: 10.1016/j.resuscitation.2012.08.329. Epub 2012 Sep 1.
To determine the rate of appropriate documentation of endotracheal tube (ET) position confirmation in the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) and to determine whether outcomes of patients who experience in-hospital cardiac arrest differ in relation to documentation rate.
Analysis of data from the GWTG-R, a prospective observational registry of in-hospital cardiac arrest and resuscitation.
Database containing clinical information from the 507 hospitals participating in the GWTG-R.
Adults resuscitated after in-hospital cardiac arrest.
The rate of appropriate documentation of ET position confirmation, defined as the use of capnography or an esophageal detector device (EDD); relationship between appropriate documentation of ET position confirmation and return of spontaneous circulation (ROSC) or survival to hospital discharge. Proportions with 95% CI are reported for prevalence data. Binary logistic regression was used to determine the relationship between appropriate documentation of ET position confirmation and outcome (ROSC, survival to hospital discharge). Adjusted and unadjusted odds ratios are reported.
Of the 176,054 patients entered into the GWTG-R database, 75,777 had an ET placed. For 13,263 (17.5%) of these patients, ET position confirmation was not documented in the chart. Auscultation alone was documented in 19,480 (25.7%) cases. Confirmation of ET position by capnography or EDD was documented in 43,034 (56.8%) cases. ROSC occurred in 39,063 (51.6%), and 13,474 (17.8%) survived to discharge. Patients whose ET position was confirmed by capnography or EDD were more likely to have ROSC (adjusted OR 1.229 [1.179, 1.282]) and to survive to hospital discharge (adjusted OR 1.093 [1.033, 1.157]).
Documentation of ET position confirmation in patients who experience cardiac arrest is suboptimal. Appropriate documentation of ET position confirmation in the GWTG-R is associated with greater likelihood of ROSC and survival to hospital discharge.
确定美国心脏协会的 Get With the Guidelines-Resuscitation（GWTG-R）中气管插管（ET）位置确认的适当记录率，并确定经历院内心脏骤停的患者的结局是否因记录率而异。
对 GWTG-R 中的数据进行分析，GWTG-R 是一个院内心脏骤停和复苏的前瞻性观察性登记处。
包含来自参与 GWTG-R 的 507 家医院的临床信息的数据库。
院内心脏骤停后复苏的成年人。
ET 位置确认的适当记录率，定义为使用二氧化碳描记法或食管探测器装置（EDD）；ET 位置确认的适当记录率与自主循环恢复（ROSC）或存活至出院之间的关系。报告流行数据的比例和 95%置信区间。使用二元逻辑回归确定 ET 位置确认与结局（ROSC、存活至出院）之间的关系。报告调整和未调整的优势比。
在纳入 GWTG-R 数据库的 176054 名患者中，有 75777 名患者放置了 ET。对于其中 13263 名（17.5%）患者，图表中未记录 ET 位置确认。在 19480 例（25.7%）病例中仅记录听诊。在 43034 例（56.8%）病例中记录了通过二氧化碳描记法或 EDD 确认 ET 位置。ROSC 发生在 39063 例（51.6%），13474 例（17.8%）存活至出院。通过二氧化碳描记法或 EDD 确认 ET 位置的患者更有可能发生 ROSC（调整后的优势比 1.229 [1.179, 1.282]）和存活至出院（调整后的优势比 1.093 [1.033, 1.157]）。
在经历心脏骤停的患者中，对 ET 位置确认的记录并不理想。在 GWTG-R 中对 ET 位置确认的适当记录与 ROSC 发生和存活至出院的可能性更大相关。
