Hoehne Sabrina N, Epstein Steven E, Hopper Kate
William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
Front Vet Sci. 2019 Nov 7;6:384. doi: 10.3389/fvets.2019.00384. eCollection 2019.
Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes "any return of spontaneous circulation (ROSC)," "sustained ROSC," and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12-6.61), = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52-15.58), = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27-0.98), = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57-7.55), = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66-0.96), = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16-20.63), < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12-12.07), = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46-0.91), = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91-56.17), = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined.
自2012年实施兽医复苏再评估运动（RECOVER）心肺复苏临床指南以来，根据兽医Utstein式心肺复苏报告指南定义的与心肺复苏（CPR）阳性结果相关的因素尚未得到描述。本研究的目的是评估美国一家兽医教学医院与心肺复苏阳性结果相关的因素，与RECOVER指南发布之前报告的因素相比，重新评估自该指南实施以来的这些因素，并确定指南发布后潜在的其他因素。本观察性研究前瞻性纳入了172只犬和47只猫，这些动物经历了心肺骤停（CPA）并接受了心肺复苏。要求指导临床医生在心肺复苏努力完成后立即填写一份关于心肺复苏事件的数据表。多变量逻辑回归用于评估20个医院、动物和骤停变量对三个患者结局“任何自主循环恢复（ROSC）”、“持续性ROSC”和存活至出院的影响。猫实现任何ROSC [比值比（95%置信区间）2.72（1.12 - 6.61），P = 0.028] 和存活至出院的几率显著高于犬 [比值比（95%置信区间）4.87（1.52 - 15.58），P = 0.008]。如果CPA发生在夜间，患者实现任何ROSC的几率显著降低 [比值比（95%置信区间）夜间 = 0.52（0.27 - 0.98），P = 0.043]，而如果CPA是目击的 [比值比（95%置信区间）3.45（1.57 - 7.55），P = 0.002]、参与心肺复苏努力的人员较少 [比值比（95%置信区间）0.8（0.66 - 0.96），P = 0.016]、心肺复苏期间可触及脉搏 [比值比（95%置信区间）9.27（4.16 - 20.63），P < 0.0005] 以及在CPA发生时已经有静脉导管 [比值比（95%置信区间）5.07（2.12 - 12.07），P = 0.0003]，则几率较高。如果参与心肺复苏努力的人员较少 [比值比（95%置信区间）0.65（0.46 - 0.91），P = 0.013] 以及对于麻醉科的患者 [比值比（95%置信区间）14.82（3.91 - 56.17），P = 0.00007]，存活至出院的几率显著更高。总体而言，自将RECOVER指南纳入日常实践以来，与改善心肺复苏结果相关的因素保持相似。目击的CPA事件和高质量的心肺复苏干预与患者的阳性结局相关，强调了及时识别和启动心肺复苏努力的重要性。最佳的心肺复苏团队规模尚未确定。
