Virginia Commonwealth University School of Medicine, Richmond, Virginia.
ZOLL, Pittsburgh, Pennsylvania.
Am J Cardiol. 2018 Jan 15;121(2):205-209. doi: 10.1016/j.amjcard.2017.10.007. Epub 2017 Nov 16.
In-hospital sudden cardiac arrests occurring during nighttime and weekend hours or within unmonitored hospital areas have been reported to have a poorer outcomes than monitored cardiac arrest. This study sought to assess the outcome of in-hospital ventricular tachycardia (VT) and ventricular fibrillation (VF) arrest by time of day, day of week, and within-hospital location when using a wearable cardioverter defibrillator (WCD). We retrospectively identified and reviewed consecutive in-hospital VT/VF arrests from January 2011 to May 2015 experienced by patients wearing a WCD using the manufacturer's postmarket registry. An index shockable sudden cardiac arrest event was defined as the first arrest caused by VT/VF. Event location and clinical outcome were extracted from patient call logs. Survival analysis was performed using the Kaplan-Meier method. A total of 234 in-hospital VT/VF arrests were included (mean age = 65 ± 12 years, male = 74%); 50% had a history of congestive heart failure. The median follow-up time was 6 days (interquartile range 1-4). In the 128 (55%) daytime events (7:00 a.m. to 7:00 p.m.), 24-hour survival was 91%. The 106 (45%) nighttime events (7:01 p.m. to 6:59 a.m.) had 89% 24-hour survival (p = 0.54). Survival outcome by monitored or unmonitored hospital locations were similar. Kaplan-Meir analyses showed no difference in 30-day survival either between weekend and weekday events (72% vs 65%, p = 0.79), or between daytime and nighttime events (64% vs 69%, p = 0.37). In conclusion, WCD use during in-hospital VT/VF arrest correlated with high survival rates regardless of event time or location inside a hospital. Use of a WCD appears to mitigate some of the risks associated with in-hospital VT/VF arrest.
在夜间和周末时段或在未监测的医院区域发生的院内心搏骤停，其预后较监测心搏骤停更差。本研究旨在评估使用可穿戴除颤器（WCD）时，根据一天中的时间、一周中的天数和医院内位置，院内室性心动过速（VT）和心室颤动（VF）骤停的结果。我们回顾性地确定并审查了 2011 年 1 月至 2015 年 5 月期间使用 WCD 的连续院内 VT/VF 骤停患者，使用制造商的上市后注册系统。首次引起 VT/VF 的可电击性心搏骤停事件被定义为索引性可电击事件。从患者呼叫记录中提取事件位置和临床结果。使用 Kaplan-Meier 法进行生存分析。共纳入 234 例院内 VT/VF 骤停（平均年龄 65 ± 12 岁，男性 74%）；50%有充血性心力衰竭史。中位随访时间为 6 天（四分位距 1-4）。在 128 例（55%）白天事件（7：00 至 19：00）中，24 小时生存率为 91%。106 例（45%）夜间事件（19：01 至次日 6：59）24 小时生存率为 89%（p=0.54）。在监测或未监测的医院位置，生存结果相似。Kaplan-Meier 分析显示，周末和工作日事件之间（72%与 65%，p=0.79）或白天和夜间事件之间（64%与 69%，p=0.37）30 天生存率无差异。结论：无论事件发生时间或院内位置如何，使用 WCD 治疗院内 VT/VF 骤停与高生存率相关。使用 WCD 似乎降低了与院内 VT/VF 骤停相关的一些风险。
