Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
PLoS One. 2019 Mar 7;14(3):e0213168. doi: 10.1371/journal.pone.0213168. eCollection 2019.
We attempted to identify factors associated with physicians' decisions to terminate CPR and to explore the role of family in the decision-making process.
We conducted a retrospective observational study in a single center in Taiwan. Patients who experienced in-hospital cardiac arrest (IHCA) between 2006 and 2014 were screened for study inclusion. Multivariate survival analysis was conducted to identify independent variables associated with IHCA outcomes using the Cox proportional hazards model.
A total of 1525 patients were included in the study. Family was present at the beginning of CPR during 722 (47.3%) resuscitation events. The median CPR duration was significantly shorter for patients with family present at the beginning of CPR than for those without family present (23.5 mins vs 30 min, p = 0.01). Some factors were associated with shorter time to termination of CPR, including arrest in an intensive care unit, Charlson comorbidity index score greater than 2, age older than 79 years, baseline evidence of motor, cognitive, or functional deficits, and vasopressors in place at time of arrest. After adjusting for confounding effects, family presence was associated with shorter time to termination of CPR (hazard ratio, 1.25; 95% confidence interval, 1.06-1.46; p = 0.008).
Clinicians' decisions concerning when to terminate CPR seemed to be based on outcome prognosticators. Family presence at the beginning of CPR was associated with shorter duration of CPR. Effective communication, along with outcome prediction tools, may avoid prolonged CPR efforts in an East Asian society.
我们试图确定与医生决定终止心肺复苏（CPR）相关的因素，并探讨家庭在决策过程中的作用。
我们在台湾的一家单中心进行了回顾性观察研究。筛选了 2006 年至 2014 年期间经历院内心搏骤停（IHCA）的患者，以确定是否符合研究纳入标准。使用 Cox 比例风险模型对多变量生存分析进行分析，以确定与 IHCA 结局相关的独立变量。
共纳入 1525 例患者。在 722 例（47.3%）复苏事件中，有家人在 CPR 开始时在场。有家人在 CPR 开始时在场的患者 CPR 持续时间中位数明显短于无家人在场的患者（23.5 分钟比 30 分钟，p = 0.01）。一些因素与 CPR 终止时间较短有关，包括在重症监护病房（ICU）中发生骤停、Charlson 合并症指数评分大于 2、年龄大于 79 岁、基线存在运动、认知或功能缺陷以及在骤停时使用血管加压素。在调整混杂效应后，家人在场与 CPR 终止时间较短相关（风险比，1.25；95%置信区间，1.06-1.46；p = 0.008）。
临床医生决定何时终止 CPR 似乎基于预后预测因素。CPR 开始时家人在场与 CPR 持续时间较短有关。在东亚社会，有效的沟通以及预后预测工具可能会避免 CPR 时间延长。
