Patel Pratik V, John Sayona, Garg Rajeev K, Temes Richard E, Bleck Thomas P, Prabhakaran Shyam
Rush University Medical Center , Department of Neurological Sciences, Chicago, Illinois.
Ther Hypothermia Temp Manag. 2011;1(4):199-203. doi: 10.1089/ther.2011.0015.
Little is known about the frequency of therapeutic hypothermia use after cardiac arrest in the United States. We, therefore, analyzed the Nationwide Inpatient Sample (NIS) to determine the prevalence of hypothermia use after cardiac arrest and patient and hospital factors associated with its use. Using 2007 NIS data, we identified adult patients with cardiac arrest using the ICD-9 diagnosis code, 427.5, while the use of therapeutic hypothermia was based on the ICD-9 procedure code, 99.81. Among 26,519 adult patients with cardiac arrest, only 92 (0.35%) were coded as having received therapeutic hypothermia. In a multivariable logistic regression model, independent factors associated with the use of therapeutic hypothermia included age as a continuous variable ([odds ratios] OR 0.97, 95% CI 0.963-0.989, p<0.001), comorbidity adjusted mortality score (OR 1.06, 95% CI 1.04-1.08, p<0.001), admission from the emergency room (OR 2.17, 95% CI 1.191-3.949, p=0.011), teaching hospital status (OR 2.68, 95% CI 1.36-5.29, p=0.005), acute myocardial infarction (OR 1.96, 95% CI 1.14-3.36, p=0.015), hospital location in the western United States (OR 2.21, 95% CI 1.16-3.14, p=0.011), and >97% registered nurse hospital staffing (OR 2.64, 95% CI 1.62-4.30, p<0.001). Therapeutic hypothermia may be utilized in <1% of cardiac arrest patients in U.S. hospitals. We identified important patient and hospital factors associated with therapeutic hypothermia utilization. Efforts to increase generalized utilization of this effective resuscitation strategy are warranted.
在美国，心脏骤停后治疗性低温的使用频率鲜为人知。因此，我们分析了全国住院患者样本（NIS），以确定心脏骤停后低温治疗的使用率以及与其使用相关的患者和医院因素。利用2007年NIS数据，我们使用国际疾病分类第九版（ICD - 9）诊断代码427.5识别心脏骤停的成年患者，而治疗性低温的使用则基于ICD - 9程序代码99.81。在26519名心脏骤停的成年患者中，只有92名（0.35%）被编码为接受了治疗性低温。在多变量逻辑回归模型中，与治疗性低温使用相关的独立因素包括作为连续变量的年龄（比值比[OR]0.97，95%置信区间0.963 - 0.989，p<0.001）、合并症调整死亡率评分（OR 1.06，95%置信区间1.04 - 1.08，p<0.001）、从急诊室入院（OR 2.17，95%置信区间1.191 - 3.949，p = 0.011）、教学医院状态（OR 2.68，95%置信区间1.36 - 5.29，p = 0.005）、急性心肌梗死（OR 1.96，95%置信区间1.14 - 3.36，p = 0.015）、医院位于美国西部（OR 2.21，95%置信区间1.16 - 3.14，p = 0.011）以及注册护士医院人员配备>97%（OR 2.64，95%置信区间1.62 - 4.30，p<0.001）。在美国医院中，心脏骤停患者中可能不到1%使用治疗性低温。我们确定了与治疗性低温使用相关的重要患者和医院因素。有必要努力提高这种有效复苏策略的广泛使用率。
