Intensive Care Unit, Groupement Hospitalier La Rochelle Ré Aunis, 17000, La Rochelle, France.
Medical Intensive Care Unit, Cochin University Hospital, Paris, France.
Intensive Care Med. 2020 May;46(5):1005-1015. doi: 10.1007/s00134-020-05992-w. Epub 2020 Mar 9.
Cardiac arrest may occur unexpectedly in intensive care units (ICU). We hypothesize that certain patient characteristics and treatments are associated with survival and long-term functional outcome following in-ICU cardiac arrest.
Over a 12-month period, cardiac arrests with resuscitation attempts were prospectively investigated in 45 French ICUs. Survivors were followed for 6 months.
In total, 677 (2.16%) of 31,399 admitted patients had at least one in-ICU cardiac arrest with resuscitation attempt, 42% of which occurred on the day of admission. In 79% cases, one or more condition(s) likely to promote the occurrence of cardiac arrest was/were identified, including hypoxia (179 patients), metabolic disorders (122), hypovolemia (94), and adverse events linked to the life-sustaining devices in place (98). Return of spontaneous circulation was achieved in 478 patients, of whom 163 were discharged alive from ICU and 146 from hospital. Six-month survival with no or moderate functional sequel (118 of 125 patients alive) correlated with a number of organ failures ≤ 2 when cardiac arrest occurred (OR 4.17 [1.92-9.09]), resuscitation time ≤ 5 min (3.32 [2.01-5.47]), shockable rhythm cardiac arrests (2.13 [1.26-3.45]) or related to the life-sustaining devices in place (2.11 [1.22-3.65]), absence of preexisting disability (1.98 [1.09-3.60]) or disease deemed fatal within 5 years (1.70 [1.05-2.77]), and sedation (1.71 [1.06-2.75]).
Only one in six patients with in-ICU cardiac arrest and resuscitation attempt was alive at 6 months with good functional status. Certain characteristics specific to cardiac arrests, resuscitation maneuvers, and the pathological context in which they happen may help clarify prognosis and inform relatives.
心脏骤停可能在重症监护病房（ICU）中突然发生。我们假设某些患者特征和治疗方法与 ICU 内心脏骤停后存活和长期功能结局相关。
在 12 个月的时间内，前瞻性调查了 45 家法国 ICU 中进行复苏尝试的心脏骤停患者。幸存者接受了 6 个月的随访。
共有 31399 名入院患者中，有 677 名（2.16%）至少发生了一次 ICU 内心脏骤停并进行了复苏尝试，其中 42%发生在入院当天。在 79%的情况下，确定了一种或多种可能导致心脏骤停的情况，包括缺氧（179 例）、代谢紊乱（122 例）、低血容量（94 例）和与生命支持设备相关的不良事件（98 例）。478 名患者恢复了自主循环，其中 163 名从 ICU 存活出院，146 名从医院存活出院。6 个月时无或中度功能后遗症（125 名存活患者中的 118 名）与心脏骤停发生时≤2 个器官衰竭（OR 4.17 [1.92-9.09]）、复苏时间≤5 分钟（3.32 [2.01-5.47]）、可除颤性节律性心脏骤停（2.13 [1.26-3.45]）或与生命支持设备相关（2.11 [1.22-3.65]）、无预先存在的残疾（1.98 [1.09-3.60]）或预计 5 年内致命的疾病（1.70 [1.05-2.77]）以及镇静（1.71 [1.06-2.75]）相关。
只有 1/6 的 ICU 内心脏骤停和复苏尝试患者在 6 个月时存活且功能状态良好。与心脏骤停、复苏操作以及发生它们的病理环境相关的某些特征可能有助于明确预后并告知家属。
