Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Denmark; Clinical Institute, Aalborg University, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
Resuscitation. 2018 Apr;125:126-134. doi: 10.1016/j.resuscitation.2018.01.001. Epub 2018 Jan 11.
With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work.
This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models.
Of 1087 30-day survivors, 212 (19.5%) were treated in an ICU with 0-1 types of organ support, 494 (45.4%) with support of two organs, 26 (2.4%) with support of three organs and 355 (32.7%) were not admitted to an ICU. Return to work increased with decreasing number of organs supported, from 53.8% (95% CI: 49.5-70.1%) in patients treated with both RRT, cardiovascular support and mechanical ventilation to 88.5% (95% CI: 85.1-91.8%) in non-ICU-patients. In 732 ICU-patients, ICU-patients with support of 3 organs had significantly lower adjusted hazard ratios (HR) of returning to work (0.50 [95% CI: 0.30-0.85] compared to ICU-patients with support of 0-1 organ. The corresponding HR was 0.48 [95% CI: 0.30-0.78] for RRT alone.
In 30-day survivors of OHCA, number of organ support therapies and in particular need of RRT were associated with reduced rate of return to work, although more than half of these latter patients still returned to work.
随着院外心脏骤停（OHCA）后存活率的提高，复苏后病程的影响变得尤为重要。在 30 天 OHCA 幸存者中，我们研究了重症监护病房（ICU）中的器官支持治疗与重返工作岗位之间的关系。
这项丹麦全国性队列研究包括在发病前有工作的 30 天 OHCA 幸存者。我们将 OHCA 数据与住院期间的治疗和重返工作岗位的信息相联系。对于入住 ICU 的患者，根据肾脏替代治疗（RRT）、心血管支持和机械通气，我们在多变量 Cox 回归模型中评估了器官支持治疗的预后价值。
在 1087 名 30 天幸存者中，212 名（19.5%）在 ICU 中接受了 0-1 种器官支持治疗，494 名（45.4%）接受了两种器官支持治疗，26 名（2.4%）接受了三种器官支持治疗，355 名（32.7%）未入住 ICU。随着支持器官数量的减少，重返工作岗位的比例逐渐增加，从接受 RRT、心血管支持和机械通气治疗的患者中 53.8%（95%CI：49.5-70.1%）到非 ICU 患者中的 88.5%（95%CI：85.1-91.8%）。在 732 名 ICU 患者中，支持 3 个器官的 ICU 患者重返工作岗位的调整后危险比（HR）显著降低（0.50 [95%CI：0.30-0.85]，与支持 0-1 个器官的 ICU 患者相比。单独接受 RRT 的 HR 为 0.48 [95%CI：0.30-0.78]。
在 OHCA 30 天幸存者中，器官支持治疗的数量，特别是对 RRT 的需求与重返工作岗位的比率降低有关，尽管这些患者中有一半以上仍重返工作岗位。
