首次心肺复苏时家属在场及随后在医学重症监护病房的护理限制

Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive Care Unit.

作者信息

Krochmal Rebecca L, Blenko John W, Afshar Majid, Netzer Giora, Roy Susan C, Wiegand Debra L, Shanholtz Carl B

机构信息

Rebecca L. Krochmal was a fellow, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland. John W. Blenko was an associate professor, Department of Anesthesiology, University of Maryland School of Medicine. Majid Afshar is an assistant professor, Division of Pulmonary and Critical Care Medicine, Loyola University School of Medicine, Maywood, IL. Giora Netzer is an associate professor, Division of Pulmonary and Critical Care Medicine, and Department of Epidemiology and Public Health, University of Maryland School of Medicine. Susan C. Roy is director, Department of Pastoral Care, University of Maryland Medical Center. Debra L. Wiegand is an associate professor, Department of Organizational Systems and Adult Health, University of Maryland School of Nursing. Carl B. Shanholtz is a professor of medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine.

出版信息

Am J Crit Care. 2017 May;26(3):221-228. doi: 10.4037/ajcc2017510.

DOI:10.4037/ajcc2017510

PMID:28461544

Abstract

BACKGROUND

The association of family-witnessed cardiopulmonary resuscitation (CPR) and subsequent advance directives in the medical intensive care unit is unknown.

OBJECTIVE

To compare clinical outcomes, including subsequent limitations on care, of family-witnessed vs family-unwitnessed CPR in the inpatient setting.

METHODS

Analysis of demographics and outcomes pertaining to family presence in a retrospective cohort of consecutive patients receiving first CPR in the medical intensive care unit of a tertiary academic medical center.

RESULTS

In 5 years, 323 patients underwent attempted CPR, of which 49 attempts (15.2%) were witnessed by family. In patients with return of spontaneous circulation, 40.9% of those whose first CPR was witnessed by family later had a do not attempt resuscitation order, which did not differ from patients whose first CPR was unwitnessed by family (31.8%). Family-witnessed CPR in the unit was associated with significantly lower rates of return of spontaneous circulation (44.9%) than was family-unwitnessed CPR (62.0%; = .02). Of all patients with a first CPR, 42 (13.0%) survived to hospital discharge. Only 1 patient with return of spontaneous circulation after first family-witnessed CPR survived to hospital discharge. In-hospital mortality for all patients requiring subsequent CPR was 97.1%.

CONCLUSIONS

For unclear reasons, family-witnessed CPR in the medical intensive care unit is associated with a similar rate of subsequent CPR efforts and lower rates of return of spontaneous circulation and survival to hospital discharge.

摘要

背景

在医学重症监护病房中，家属见证的心肺复苏（CPR）与后续的预立医疗指示之间的关联尚不清楚。

目的

比较住院环境下家属见证的心肺复苏与家属未见证的心肺复苏的临床结局，包括后续的医疗限制。

方法

对在一所三级学术医疗中心的医学重症监护病房接受首次心肺复苏的连续患者的回顾性队列进行分析，涉及家属在场情况的人口统计学和结局。

结果

在5年时间里，323例患者接受了心肺复苏尝试，其中49次尝试（15.2%）有家属见证。在自主循环恢复的患者中，首次心肺复苏有家属见证的患者中，40.9%后来下达了不进行心肺复苏的医嘱，这与首次心肺复苏无家属见证的患者（31.8%）并无差异。该病房中家属见证的心肺复苏与自主循环恢复率显著低于家属未见证的心肺复苏（分别为44.9%和62.0%；P = 0.02）。在所有接受首次心肺复苏的患者中，42例（13.0%）存活至出院。首次家属见证的心肺复苏后仅有1例自主循环恢复的患者存活至出院。所有需要后续心肺复苏的患者的院内死亡率为97.1%。