Department of General Surgery, Stanford University, Palo Alto, California.
J Hosp Med. 2014 Jan;9(1):29-34. doi: 10.1002/jhm.2127. Epub 2013 Dec 6.
There is a paucity of data examining the epidemiology of recipients of multiple in-hospital cardiopulmonary resuscitation (CPR) attempts, and their outcomes.
Nationwide Inpatient Sample, 2000 to 2009. Patient characteristics, survival to discharge, discharge disposition, and cost of hospitalization of patients who had 1 versus multiple (>1) CPR attempts were compared using bivariate and multivariate methods.
Of 166,519 hospitalized CPR recipients, 3.4% had multiple CPR attempts. Compared with 1-time CPR recipients, those undergoing multiple CPR were younger (age <65 years; 37.3% vs 42.5%, respectively), more often nonwhite (34.2% vs 41.4%), and commonly treated in nonteaching hospitals (58.0% vs 64.5%; all P < 0.001). Survival to discharge decreased by >40% for each additional CPR attempt (23.4% vs 11.9%, and 6.7% for 1, 2, and ≥3 CPR attempts, respectively; P < 0.001). After multivariate adjustment, multiple CPR was independently associated with a lower survival to discharge (odds ratio: 0.41, 95% confidence interval: 0.37-0.44, P < 0.001). Recipients of multiple CPR were more likely to be discharged to destinations other than home (80.7% vs 70.1%, P < 0.001); 1 in 15 survivors of multiple CPR were discharged to hospice (6.8%), compared with 1 in 23 patients (4.3%) who had 1 CPR (P = 0.002). The average cost per day of hospitalization was higher for patients who had multiple CPR versus 1 CPR ($4484.60 vs $3581.40, P < 0.001).
Recipients of multiple in-hospital CPR attempts are more likely to be younger, nonwhite, and treated in nonteaching hospitals. Survival to discharge is significantly worse, and the cost of hospitalization is considerably higher for these patients.
目前有关多次院内心肺复苏（CPR）接受者及其预后的流行病学数据十分有限。
2000 年至 2009 年全国住院患者样本。使用双变量和多变量方法比较了 1 次与多次（>1 次）CPR 尝试的患者的患者特征、出院存活率、出院去向和住院费用。
在 166519 名接受院内 CPR 的住院患者中，有 3.4%的患者经历了多次 CPR。与接受 1 次 CPR 的患者相比，多次 CPR 的患者更年轻（年龄<65 岁；分别为 37.3%和 42.5%），非白人患者更多（分别为 34.2%和 41.4%），并且通常在非教学医院接受治疗（分别为 58.0%和 64.5%；所有 P 值均<0.001）。每次额外的 CPR 尝试，出院存活率下降超过 40%（分别为 23.4%、11.9%和 6.7%，用于 1、2 和≥3 次 CPR 尝试；P 值均<0.001）。多变量调整后，多次 CPR 与出院存活率降低独立相关（比值比：0.41，95%置信区间：0.37-0.44，P 值<0.001）。多次 CPR 的接受者更有可能被送往非家庭的目的地（80.7%和 70.1%，P 值<0.001）；15 名多次 CPR 幸存者中就有 1 人被送往临终关怀（6.8%），而 23 名接受 1 次 CPR 的患者中就有 1 人（4.3%）被送往临终关怀（P 值=0.002）。与接受 1 次 CPR 的患者相比，多次 CPR 的患者每天的住院费用平均高出 4484.60 美元（4484.60 美元与 3581.40 美元，P 值<0.001）。
多次院内 CPR 的接受者更有可能是年轻、非白人并且在非教学医院接受治疗。出院存活率显著降低，这些患者的住院费用也高得多。
