多学科 ICU 心脏骤停病例讨论改善生存结局*。
Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes*.
机构信息
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Pediatrics, Section of Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
出版信息
Crit Care Med. 2014 Jul;42(7):1688-95. doi: 10.1097/CCM.0000000000000327.
OBJECTIVE
In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events.
DESIGN, SETTING, AND PATIENTS: Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU.
INTERVENTIONS
Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers.
MEASUREMENTS AND MAIN RESULTS
Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed "excellent cardiopulmonary resuscitation," prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91-6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01-7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9-10.6; p < 0.01).
CONCLUSION
Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome.
目的
院内心搏骤停是一个重要的公共卫生问题。高质量的复苏可提高存活率，但实施难度较大。我们的目的是评估一种新的、跨学科的、事后定量的复苏后讨论方案，以改善院内儿科胸外按压事件后的生存结局。
设计、地点和患者：对 2008 年 12 月至 2012 年 6 月期间 ICU 内接受胸外按压的儿童进行的单中心前瞻性干预性研究。
干预措施
对一线医护人员进行结构化、定量、视听、跨学科的胸外按压事件复苏后讨论。
测量和主要结果
主要结局是存活至出院。次要结局包括事件存活率（自主循环恢复≥20min）和有利的神经结局。主要复苏质量结局是一个复合变量，称为“优秀心肺复苏”，前瞻性定义为按压深度≥38mm、频率≥100/min、≤10%的按压中存在倾斜、以及在给定的 30 秒时相中胸外按压分数>90%。仅对 8 岁及以上的患者有定量数据。共有 119 次胸外按压事件（对照组 60 例，干预组 59 例）。该干预措施与未校正时的出院存活率提高趋势相关（52%对 33%，p=0.054），校正混杂因素后仍相关（校正比值比，2.5；95%可信区间，0.91-6.8；p=0.075），且与未校正时有利的神经结局存活率提高相关（50%对 29%，p=0.036）和校正后相关（校正比值比，2.75；95%可信区间，1.01-7.5；p=0.047）。在讨论期间，年龄≥8 岁的患者的心肺复苏周期发生符合优秀心肺复苏标准的可能性增加 5.6 倍（95%可信区间，2.9-10.6；p<0.01）。
结论
实施跨学科的、事后定量的复苏后讨论方案与心肺复苏质量提高和有利的神经结局存活率提高显著相关。
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