Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
School of Aging Studies, University of South Florida, Tampa, FL, USA.
J Intensive Care Med. 2019 Mar;34(3):252-258. doi: 10.1177/0885066617707921. Epub 2017 May 11.
We sought to examine temporal trends in management (ie, use of extracorporeal membrane oxygenation [ECMO], therapeutic hypothermia [TH], coronary angiogram, and percutaneous coronary intervention [PCI]) and in-hospital mortality in adults hospitalized with cardiac arrest.
Utilizing the Nationwide Inpatient Sample, medical history, clinical management, and in-hospital mortality were assessed in 942 495 hospitalizations in adults with cardiac arrest (identified through codes) from 2006 to 2012.
From 2006 to 2012, there was an overall rise in the use of coronary angiogram (12.8%, 13.0%, 14.7%, 15.0%, 14.3%, 14.7%, and 15.8%), PCI (7.5%, 7.1%, 8.4%, 8.1%, 8.1%, 8.4%, and 8.9%), TH (0.2%, 0.3%, 0.6%, 1.2%, 1.9%, 2.8%, and 3.0%), and ECMO (0.1%, 0.1%, 0.1%, 0.2%, 0.2%, 0.3%, and 0.4%; < .001 for all). In-hospital mortality significantly decreased over the 7-year study period (65.5%, 63.4%, 59.3%, 57.9%, 57.0%, 56.0%, and 56.3% from 2006 to 2012). In multivariable analysis, a 31% decrease in mortality was accompanied by a concomitant 24% and 27% increase in coronary angiogram and PCI, respectively, during the study period. Therapeutic hypothermia and ECMO were associated with an approximate 11-fold and 7-fold increase, respectively, from 2006 to 2012. The strongest predictors of use of ECMO, TH, coronary angiogram, and PCI were younger age and the presence of coronary artery disease.
During 2006 to 2012, a decline in mortality was accompanied by a steady rise in the use of ECMO, TH, coronary angiogram, and PCI in adults hospitalized with cardiac arrest. Patients of younger age and with coronary artery disease were more likely to receive these advanced therapies.
我们旨在研究成人心脏骤停患者的治疗管理（即体外膜肺氧合[ECMO]、治疗性低温[TH]、冠状动脉造影和经皮冠状动脉介入治疗[PCI]）和院内死亡率的时间趋势。
利用全国住院患者样本，评估了 2006 年至 2012 年期间 942495 例通过（代码）识别的心脏骤停（成人）住院患者的病史、临床管理和院内死亡率。
2006 年至 2012 年，冠状动脉造影（12.8%、13.0%、14.7%、15.0%、14.3%、14.7%和 15.8%）、PCI（7.5%、7.1%、8.4%、8.1%、8.1%、8.4%和 8.9%）、TH（0.2%、0.3%、0.6%、1.2%、1.9%、2.8%和 3.0%）和 ECMO（0.1%、0.1%、0.1%、0.2%、0.2%、0.3%和 0.4%；所有<.001）的使用均呈总体上升趋势。在 7 年的研究期间，院内死亡率显著下降（2006 年至 2012 年分别为 65.5%、63.4%、59.3%、57.9%、57.0%、56.0%和 56.3%）。多变量分析显示，在此期间，死亡率下降了 31%，同时冠状动脉造影和 PCI 分别增加了 24%和 27%。TH 和 ECMO 的使用分别增加了约 11 倍和 7 倍。ECMO、TH、冠状动脉造影和 PCI 使用的最强预测因素是年龄较小和存在冠状动脉疾病。
2006 年至 2012 年间，随着心脏骤停成年患者死亡率的下降，ECMO、TH、冠状动脉造影和 PCI 的使用呈稳步上升趋势。年龄较小和患有冠状动脉疾病的患者更有可能接受这些先进的治疗方法。
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