Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Resuscitation. 2019 Mar;136:93-99. doi: 10.1016/j.resuscitation.2019.01.031. Epub 2019 Jan 30.
There is no standard for categorizing reasons for death in those who achieve return of spontaneous circulation (ROSC) after cardiac arrest but die before hospital discharge. Categorization is important for comparing outcomes across studies, assessing benefits of interventions, and developing quality-improvement initiatives. We developed and tested a method for categorizing reasons for death after cardiac arrest in both in-hospital (IHCA) and out-of-hospital (OHCA) arrests.
Single-center, retrospective, cohort study of patients with ROSC after IHCA or OHCA between 2008 and 2017 who died before hospital discharge. Traumatic arrests and patients with "do-not-resuscitate" orders prior to their arrest were excluded. Two investigators assigned each patient to one of five predefined reasons for death. Interrater reliability was assessed using Fleiss' kappa. For final categorization, discrepancies were resolved by a third investigator.
There were 182 IHCA and 226 OHCA included. There was substantial agreement between raters (kappa of 0.62 and 0.61 for IHCA and OHCA, respectively). Reasons for death for IHCA and OHCA were: neurological withdrawal of care (27% vs 73%), comorbid withdrawal of care (36% vs 4%), refractory hemodynamic shock (25% vs 17%), respiratory failure (1% vs 3%), and sudden cardiac death (11% vs 4%). The differences in reasons for death among the two groups were significant (p-value < 0.001).
Categorizing reasons for death after cardiac arrest with ROSC is feasible using our proposed categories, with substantial inter-rater agreement. Neurologic withdrawal of care is much less common in IHCA than OHCA, which may have implications for further research.
在心跳骤停后恢复自主循环（ROSC）但在出院前死亡的患者中，死亡原因尚无分类标准。分类对于比较研究结果、评估干预措施的益处以及制定质量改进计划非常重要。我们开发并测试了一种用于分类院内（IHCA）和院外（OHCA）心跳骤停后 ROSC 患者死亡原因的方法。
这是一项单中心、回顾性队列研究，纳入了 2008 年至 2017 年期间 ROSC 后在 IHCA 或 OHCA 中死亡的患者。排除创伤性心跳骤停和在心跳骤停前下达“不复苏”医嘱的患者。两名研究者将每位患者分配到五个预先定义的死亡原因之一。使用 Fleiss' kappa 评估评分者间的可靠性。对于最终分类，通过第三名研究者解决差异。
共纳入 182 例 IHCA 和 226 例 OHCA。两名评分者之间存在高度一致性（IHCA 和 OHCA 的kappa 值分别为 0.62 和 0.61）。IHCA 和 OHCA 的死亡原因分别为：神经放弃治疗（27% vs 73%）、合并症放弃治疗（36% vs 4%）、难治性血流动力学休克（25% vs 17%）、呼吸衰竭（1% vs 3%）和心源性猝死（11% vs 4%）。两组之间的死亡原因存在显著差异（p 值<0.001）。
使用我们提出的类别对心跳骤停后恢复自主循环（ROSC）的患者进行死亡原因分类是可行的，评分者间的一致性较高。神经放弃治疗在 IHCA 中比 OHCA 中要少见得多，这可能对进一步的研究有影响。
