Dresden Scott M, O'Connor Lanty M, Pearce Charles G, Courtney D Mark, Powell Emilie S
1 Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
Ther Hypothermia Temp Manag. 2015 Mar;5(1):48-54. doi: 10.1089/ther.2014.0023. Epub 2015 Jan 7.
Therapeutic hypothermia (TH) in cardiac arrest continues to be underused in the United States. A better understanding of its utilization could inform future efforts and policies to improve utilization. This study investigates trends in TH use for in and out-of-hospital cardiac arrest, and hospital factors associated with its use.
We performed a cross-sectional analysis using the Nationwide Inpatient Sample (NIS), 2007-2010, of US adult hospitalizations with cardiac arrest. Annual rates of TH use and proportions of hospitals using TH were calculated using NIS weighting. Potential hospital factors associated with increased likelihood of TH utilization were assessed using logistic regression.
Across 2007-2010, 1.35% of cardiac arrest patients received TH; increasing from 0.34% (2007) to 2.49% (2010). The proportion of hospitals using TH was 13.63%, increasing from 4.63% (2007) to 22.16% (2010). Significant hospital factors associated with TH utilization were: large hospitals, urban location, Northeast or West regions, teaching hospitals, non-safety net hospitals, increasing year, and hospitals with higher annual cardiac arrest volume.
Utilization of TH in cardiac arrest remains low, but increased sevenfold from 2007 to 2010. The significant variability in implementation of TH, argues for nationwide best practices or regionalization of postcardiac arrest care hospitals.
在美国，心脏骤停患者的治疗性低温疗法（TH）的使用率仍然很低。更好地了解其使用情况可为未来提高使用率的努力和政策提供参考。本研究调查了院内外心脏骤停患者使用TH的趋势以及与其使用相关的医院因素。
我们使用2007 - 2010年全国住院患者样本（NIS）对美国成年心脏骤停住院患者进行了横断面分析。使用NIS权重计算TH的年使用率和使用TH的医院比例。使用逻辑回归评估与TH使用可能性增加相关的潜在医院因素。
在2007 - 2010年期间，1.35%的心脏骤停患者接受了TH治疗；从2007年的0.34%增至2010年的2.49%。使用TH的医院比例为13.63%，从2007年的4.63%增至2010年的22.16%。与TH使用相关的显著医院因素包括：大型医院、城市地区、东北部或西部地区、教学医院、非安全网医院、年份增加以及年度心脏骤停病例数较多的医院。
心脏骤停患者中TH的使用率仍然很低，但在2007年至2010年间增长了七倍。TH实施方面存在显著差异，这表明需要制定全国性的最佳实践或对心脏骤停后护理医院进行区域化管理。
