Bhardwaj Abhishek, Ikeda Daniel J, Grossestreuer Anne V, Sheak Kelsey R, Delfin Gail, Layden Timothy, Abella Benjamin S, Leary Marion
Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA.
Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Resuscitation. 2017 Feb;111:90-95. doi: 10.1016/j.resuscitation.2016.12.007. Epub 2016 Dec 16.
To examine patient- and arrest-level factors associated with the incidence of re-arrest in the hospital setting, and to measure the association between re-arrest and survival to discharge.
This work represents a retrospective cohort study of adult patients who were successfully resuscitated from an initial out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (ICHA) of non-traumatic origin at two urban academic medical centers. In this study, re-arrest was defined as loss of a pulse following 20min of sustained return of spontaneous circulation (ROSC).
Between 01/2005 and 04/2016, 1961 patients achieved ROSC following non-traumatic cardiac arrest. Of those, 471 (24%) experienced at least one re-arrest. In re-arrest patients, the median time from initial ROSC to first re-arrest was 5.4h (IQR: 1.1, 61.8). The distribution of initial rhythms between single- and re-arrest patients did not vary, nor did the median duration of initial arrest. Among 108 re-arrest patients with an initial shockable rhythm, 60 (56%) experienced a shockable re-arrest rhythm. Among 273 with an initial nonshockable rhythm, 31 (11%) experienced a shockable re-arrest rhythm. After adjusting for significant covariates, the incidence of re-arrest was associated with a lower likelihood of survival to discharge (OR: 0.32; 95% CI: 0.24-0.43; p<0.001).
Re-arrest is a common complication experienced by cardiac arrest patients that achieve ROSC, and occurs early in the course of their post-arrest care. Moreover, re-arrest is associated with a decreased likelihood of survival to discharge, even after adjustments for relevant covariates.
研究与医院环境中再次心脏骤停发生率相关的患者及心脏骤停层面的因素，并衡量再次心脏骤停与出院存活率之间的关联。
本研究为一项回顾性队列研究，研究对象为在两家城市学术医疗中心从非创伤性原因导致的院外心脏骤停（OHCA）或院内心脏骤停（ICHA）中成功复苏的成年患者。在本研究中，再次心脏骤停定义为在自主循环恢复（ROSC）持续20分钟后脉搏消失。
在2005年1月至2016年4月期间，1961例患者在非创伤性心脏骤停后实现了ROSC。其中，471例（24%）经历了至少一次再次心脏骤停。在再次心脏骤停患者中，从初始ROSC到首次再次心脏骤停的中位时间为5.4小时（四分位间距：1.1，61.8）。单次心脏骤停患者和再次心脏骤停患者的初始心律分布没有差异，初始心脏骤停的中位持续时间也没有差异。在108例初始心律可电击复律的再次心脏骤停患者中，60例（56%）经历了可电击复律的再次心脏骤停心律。在273例初始心律不可电击复律的患者中，31例（11%）经历了可电击复律的再次心脏骤停心律。在对显著协变量进行调整后，再次心脏骤停的发生率与出院存活率较低相关（比值比：0.32；95%置信区间：0.24 - 0.43；p<0.001）。
再次心脏骤停是实现ROSC的心脏骤停患者常见的并发症，且发生在心脏骤停后护理过程的早期。此外，即使在对相关协变量进行调整后，再次心脏骤停与出院存活率降低相关。
