Department of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0570, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Resuscitation. 2018 Mar;124:112-117. doi: 10.1016/j.resuscitation.2018.01.020. Epub 2018 Jan 11.
Palliative care (PC) has become an integral component of comprehensive care provided to critically ill patients. Little is known about the utilization of palliative care following Out-of-Hospital Cardiac Arrest (OHCA) in the United States.
We used the 2002-2013 National Inpatient Sample database to identify adults ≥18 years old with an ICD-9-CM principal diagnosis code of cardio-respiratory arrest or ventricular fibrillation (VF). Patients were categorized into two groups based on the presence of PC, then compared using Pearson χ test for categorical variables and linear regression for continuous variables. Multiple linear and logistic regression models were conducted to identify factors associated with PC, and temporal trends in PC utilization.
Of the 154,177 patients hospitalized with OHCA in the U.S, 11,260 (7.3%) had PC consultations during hospitalization. PC Utilization increased from 1.5% in 2002 to 16.7% in 2013 (P-trend < 0.001). Patients who received Palliative care were older (mean age 70.7 ± 0.3 vs 65.9 ± 0.1), more likely to be female (45.8% vs 40.5%), and had higher Charlson comorbidity index ≥2 (55.8% vs 46.8%). In adjusted analyses, older age, female gender, Caucasian race, higher Charlson comorbidity index, multiorgan failure, metastatic cancer, non-shockable rhythm, admission to larger, urban and teaching hospitals were all associated with higher PC utilization.
We observed significant increase in the utilization of palliative care consultations following OHCA over the study period. This was influenced by multiple patient and hospital factors. Further investigations are needed to identify the appropriate cost-effective use of palliative care following cardiac arrest.
姑息治疗（PC）已成为为危重症患者提供综合治疗的一个组成部分。在美国，关于心脏骤停后（OHCA）姑息治疗的应用知之甚少。
我们使用 2002-2013 年国家住院患者样本数据库，确定 ICD-9-CM 主要诊断代码为心肺骤停或心室颤动（VF）的≥18 岁成年人。根据 PC 的存在，将患者分为两组，然后使用 Pearson χ 检验进行分类变量比较，使用线性回归进行连续变量比较。进行多元线性和逻辑回归模型，以确定与 PC 相关的因素，并确定 PC 利用的时间趋势。
在美国，154177 例 OHCA 住院患者中，有 11260 例（7.3%）在住院期间接受了 PC 咨询。PC 的利用率从 2002 年的 1.5%增加到 2013 年的 16.7%（P 趋势<0.001）。接受姑息治疗的患者年龄较大（平均年龄 70.7±0.3 岁 vs. 65.9±0.1 岁），更可能为女性（45.8% vs. 40.5%），且 Charlson 合并症指数≥2（55.8% vs. 46.8%）较高。在调整分析中，年龄较大、女性、白种人、Charlson 合并症指数较高、多器官衰竭、转移性癌症、非可除颤节律、收入较大、城市和教学医院均与较高的 PC 利用率相关。
在研究期间，我们观察到 OHCA 后姑息治疗咨询的利用率显著增加。这受到多个患者和医院因素的影响。需要进一步研究以确定心脏骤停后姑息治疗的适当成本效益利用。
