Fletcher James W A, Smith Adam, Walsh Katherine, Riddick Andrew
Department for Health, University of Bath, Bath, United Kingdom.
Severn Postgraduate Medical Education School of Surgery, Bristol, United Kingdom.
Geriatr Orthop Surg Rehabil. 2019 Jan 16;10:2151459318818972. doi: 10.1177/2151459318818972. eCollection 2019.
Despite awareness of overall poor survival rates following cardiopulmonary resuscitation (CPR), some orthopedic patients with significant comorbidities continue to have inappropriate resuscitation plans. Furthermore, in certain injury groups such as patients with hip fractures, survival outcome data are very limited; current discussions regarding resuscitation plans may be inaccurate. This study assesses survival in orthopedic patients following CPR, to inform decision-making between physicians, surgeons, and patients.
A dual center, retrospective cohort study was performed analyzing all orthopedic admissions that received CPR over a 25-month period, with a minimum of 1 year follow-up. National Cardiac Arrest Audit data, "mortality and morbidity" meeting records, National Hip Fracture Databases, and electronic notes were analyzed. Survival duration was measured, alongside reason for admission, location CPR occurred, and initial rhythm encountered.
Thirty-two patients received CPR over the 25-month period (median age: 83; range: 30-96). Three (9%) of 32 patients survived to discharge. Only 1 of the 26 patients older than 65 years survived to discharge. Fifteen (47%) of 32 had hip fractures, where 4 (27%) of 15 of this group survived 24 hours; none survived to discharge. When recorded, 22 (92%) of 24 initially had a nonshockable rhythm.
Cardiopulmonary resuscitation was conceptualized as a treatment for reversible cardiopulmonary causes. When used in trauma and orthopedic patients, especially older and/or hip fracture patients, it seldom led to hospital discharge. Different admission practices such as "front door" orthogeriatric reviews may explain the contrast in usage of CPR between the hospitals.
Survival rates following CPR were very low, with it proving specifically ineffective in hip fracture patients. Although every decision about resuscitation should be patient centered and individualized, this study will allow clinicians to be more realistic about outcomes from CPR, particularly in the hip fracture group.
尽管人们意识到心肺复苏（CPR）后的总体生存率很低，但一些合并症严重的骨科患者仍继续存在不恰当的复苏计划。此外，在某些损伤群体中，如髋部骨折患者，生存结局数据非常有限；目前关于复苏计划的讨论可能并不准确。本研究评估了骨科患者心肺复苏后的生存率，以为医生、外科医生和患者之间的决策提供参考。
进行了一项双中心回顾性队列研究，分析了在25个月期间接受心肺复苏的所有骨科住院患者，并进行了至少1年的随访。分析了国家心脏骤停审计数据、“死亡率和发病率”会议记录、国家髋部骨折数据库和电子病历。测量了生存时间，以及入院原因、心肺复苏发生的地点和最初遇到的心律。
在25个月期间，32名患者接受了心肺复苏（中位年龄：83岁；范围：30 - 96岁）。32名患者中有3名（9%）存活至出院。65岁以上的26名患者中只有1名存活至出院。32名患者中有15名（47%）发生髋部骨折，该组15名患者中有4名（27%）存活24小时；无一人存活至出院。记录显示，24名患者中有22名（92%）最初心律不可电击。
心肺复苏被概念化为一种针对可逆性心肺病因的治疗方法。当用于创伤和骨科患者，尤其是老年和/或髋部骨折患者时，很少能导致出院。不同的入院做法，如“前门”老年骨科评估，可能解释了医院之间心肺复苏使用情况的差异。
心肺复苏后的生存率非常低，事实证明其在髋部骨折患者中尤其无效。尽管关于复苏的每一个决定都应以患者为中心并个体化，但本研究将使临床医生对心肺复苏的结果更现实，特别是在髋部骨折组。
