Snipelisky David, Dumitrascu Adrian, Ray Jordan, Roy Archana, Matcha Gautam, Harris Dana, Vadeboncoeur Tyler, Kusumoto Fred, Burton M Caroline
a Department of Medicine, Division of Cardiovascular Diseases , Mayo Clinic , Rochester , MN, USA.
b Department of Medicine, Division of Hospital Medicine , Mayo Clinic , Jacksonville , FL , USA.
Acute Card Care. 2016 Dec;18(4):79-84. doi: 10.1080/17482941.2017.1408917. Epub 2017 Dec 6.
Guidelines recommend discussing code status with patients on hospital admission. No study has evaluated the feasibility of a full code with do not intubate (DNI) status. A retrospective analysis of patients who experienced a cardiopulmonary arrest was performed between May 1, 2008 and June 20, 2014. A descriptive analysis was created based on whether patients required mechanical ventilatory support during the hospitalization and comparisons were made between both patient subsets. A total of 239 patients were included. Almost all (n = 218, 91.2%) required intubation during the hospitalization. Over half (n = 117, 53.7%) were intubated on the same day as the cardiopulmonary arrest and 91 patients (41.7%) were intubated at the time of arrest. Comparisons between intubated and non-intubated patients showed little differences in clinical characteristics, except for a higher proportion of medical cardiac etiology for admission in patients who did not require intubation (n = 10, 47.6% versus n = 55, 25.2%; = 0.18) and initial arrest rhythm of ventricular tachycardia/fibrillation (n = 8, 38.1% versus n = 50, 22.9%; = 0.37). No differences in 24-hour and posthospital survivals were present. Mechanical ventilatory support is commonly utilized in patients who experience a cardiopulmonary arrest. The DNI status may not be a feasible code status option for most patients.
指南建议在患者入院时与他们讨论急救状态。尚无研究评估完全心肺复苏与不插管(DNI)状态的可行性。对2008年5月1日至2014年6月20日期间经历心肺骤停的患者进行了回顾性分析。根据患者在住院期间是否需要机械通气支持进行描述性分析,并对两个患者亚组进行比较。共纳入239例患者。几乎所有患者(n = 218,91.2%)在住院期间都需要插管。超过一半(n = 117,53.7%)在心肺骤停当天插管,91例患者(41.7%)在骤停时插管。插管患者与未插管患者的比较显示,临床特征差异不大,只是不需要插管的患者因心脏病入院的比例更高(n = 10,47.6%对n = 55,25.2%;P = 0.18),以及初始骤停心律为室性心动过速/心室颤动的比例更高(n = 8,38.1%对n = 50,22.9%;P = 0.37)。24小时生存率和出院后生存率无差异。经历心肺骤停的患者通常需要机械通气支持。对于大多数患者来说,DNI状态可能不是一个可行的急救状态选项。