Saint Luke's Mid America Heart Institute, Kansas City, Missouri2Department of Medicine, University of Missouri, Kansas City.
The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann A.
JAMA Cardiol. 2016 May 1;1(2):189-97. doi: 10.1001/jamacardio.2016.0073.
Although survival of patients with in-hospital cardiac arrest varies markedly among hospitals, specific resuscitation practices that distinguish sites with higher cardiac arrest survival rates remain unknown.
To identify resuscitation practices associated with higher rates of in-hospital cardiac arrest survival.
DESIGN, SETTING, AND PARTICIPANTS: Nationwide survey of resuscitation practices at hospitals participating in the Get With the Guidelines-Resuscitation registry and with 20 or more adult in-hospital cardiac arrest cases from January 1, 2012, through December 31, 2013. Data analysis was performed from June 10 to December 22, 2015.
Risk-standardized survival rates for cardiac arrest were calculated at each hospital and were then used to categorize hospitals into quintiles of performance. The association between resuscitation practices and quintiles of survival was evaluated using hierarchical proportional odds logistic regression models.
Overall, 150 (78.1%) of 192 eligible hospitals completed the study survey, and 131 facilities with 20 or more adult in-hospital cardiac arrest cases comprised the final study cohort. Risk-standardized survival rates after in-hospital cardiac arrest varied substantially (median, 23.7%; range, 9.2%-37.5%). Several resuscitation practices were associated with survival on bivariate analysis, although only 3 were significant after multivariable adjustment: monitoring for interruptions in chest compressions (adjusted odds ratio [OR] for being in a higher survival quintile category, 2.71; 95% CI, 1.24-5.93; P = .01), reviewing cardiac arrest cases monthly (adjusted OR for being in a higher survival quintile category, 8.55; 95% CI, 1.79-40.00) or quarterly (OR, 6.85; 95% CI, 1.49-31.30; P = .03), and adequate resuscitation training (adjusted OR, 3.23; 95% CI, 1.21-8.33; P = .02).
Using survey information from acute care hospitals participating in a national quality improvement registry, we identified 3 resuscitation strategies associated with higher hospital rates of survival for patients with in-hospital cardiac arrest. These strategies can form the foundation for best practices for resuscitation care at hospitals given the high incidence and variation in survival for in-hospital cardiac arrest.
尽管医院内心脏骤停患者的存活率存在显著差异，但仍不清楚哪些复苏实践可区分出存活率较高的场所。
确定与院内心脏骤停存活率较高相关的复苏实践。
设计、地点和参与者：对参与 Get With the Guidelines-Resuscitation 注册研究的医院以及 2012 年 1 月 1 日至 2013 年 12 月 31 日期间发生 20 例或更多成人院内心脏骤停病例的医院进行了全国性复苏实践调查。数据分析于 2015 年 6 月 10 日至 12 月 22 日进行。
计算了每家医院的心脏骤停风险标准化生存率，并将医院分为五分位数绩效类别。使用分层比例优势逻辑回归模型评估复苏实践与生存率五分位数之间的关系。
共有 192 家符合条件的医院中的 150 家（78.1%）完成了研究调查，131 家有 20 例或更多成人院内心脏骤停病例的医院构成了最终的研究队列。院内心脏骤停后的风险标准化生存率差异很大（中位数，23.7%；范围，9.2%-37.5%）。虽然多变量调整后只有 3 个因素具有统计学意义，但在单变量分析中，许多复苏实践与生存率相关：监测胸外按压中断（五分位数分类中处于更高生存率类别的调整比值比，2.71；95%置信区间，1.24-5.93；P=0.01）、每月（调整比值比，8.55；95%置信区间，1.79-40.00）或每季度（比值比，6.85；95%置信区间，1.49-31.30；P=0.03）审查心脏骤停病例以及充分的复苏培训（调整比值比，3.23；95%置信区间，1.21-8.33；P=0.02）。
使用来自参与国家质量改进注册研究的急症护理医院的调查信息，我们确定了与院内心脏骤停患者医院生存率较高相关的 3 种复苏策略。鉴于院内心脏骤停的高发生率和生存率差异，这些策略可以为医院的复苏护理提供最佳实践的基础。
