介入放射学中的医疗急症和心肺骤停。

Medical emergencies and cardiopulmonary arrests in interventional radiology.

机构信息

Division of Interventional Radiology and Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

出版信息

J Vasc Interv Radiol. 2013 Dec;24(12):1779-85. doi: 10.1016/j.jvir.2013.07.027. Epub 2013 Oct 3.

DOI:10.1016/j.jvir.2013.07.027

PMID:24094517

Abstract

PURPOSE

To evaluate the circumstances and determine the outcomes of medical emergencies (MEs) and cardiopulmonary arrests (CPAs) in patients undergoing interventional radiology (IR) procedures.

MATERIALS AND METHODS

Retrospective review of all MEs and CPAs that occurred between July 2006 and December 2011 was performed. Procedure type, technical outcome, complications, etiology and location of ME/CPA, event outcome, and postevent mortality were collected.

RESULTS

A total of 58 events occurred during 38,927 procedures (0.15%). Complete records were available for 55 events (43 MEs, 12 CPAs) in 53 patients (mean age, 63 y; 58.5% male) during 37 inpatient (27 MEs, 10 CPAs) and 18 outpatient (16 MEs, two CPAs) encounters. Seven events (13%; six MEs, one CPA) occurred before the start of the procedure, and 18 (33%; 16 MEs, two CPAs) occurred in the periprocedural holding area. Thirty-five procedures (64%) were completed successfully. Forty-two patients (76%) were alive at discharge, 37 (67%) at 1 month, 26 (47%) at 3 months, and 23 (42%) at 1 year. Procedural complications were attributed as the main cause of 22 MEs (51%) and one CPA (8%; P = .018). The relative risk (RR) of an ME or CPA occurring during a hemodialysis access case versus all other cases was 5.2 (95% confidence interval = 3.02-8.95; P < .0001).

CONCLUSIONS

Although the incidence of MEs/CPAs in patients undergoing IR procedures is low, the 1-year mortality rate following these events is high. MEs are significantly more likely than CPAs to be directly attributed to a procedural complication. The RR of MEs/CPAs is significantly higher in hemodialysis access interventions.

摘要

目的

评估介入放射学（IR）程序中发生的医疗紧急情况（MEs）和心肺骤停（CPAs）的情况并确定其结局。

材料和方法

回顾性分析了 2006 年 7 月至 2011 年 12 月期间发生的所有 MEs 和 CPAs。收集了程序类型、技术结果、并发症、ME/CPA 的病因和位置、事件结局以及事件后死亡率。

结果

在 38927 例手术中，共发生了 58 例事件（0.15%）。共记录了 53 例患者（平均年龄 63 岁；58.5%为男性）55 例事件（43 例 ME，12 例 CPA）的完整记录，包括 37 例住院（27 例 ME，10 例 CPA）和 18 例门诊（16 例 ME，2 例 CPA）。7 例事件（13%；6 例 ME，1 例 CPA）发生在手术开始前，18 例（33%；16 例 ME，2 例 CPA）发生在围手术期的等候区。35 例手术（64%）成功完成。42 例患者（76%）出院时存活，37 例（67%）在 1 个月时存活，26 例（47%）在 3 个月时存活，23 例（42%）在 1 年时存活。程序并发症被认为是 22 例 ME（51%）和 1 例 CPA（8%）的主要原因（P =.018）。与所有其他病例相比，行血液透析通路病例发生 ME 或 CPA 的相对风险（RR）为 5.2（95%置信区间=3.02-8.95；P<.0001）。