Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2020 Dec;96(7):1350-1359. doi: 10.1002/ccd.28854. Epub 2020 Mar 17.
Patients with concomitant cardiac arrest (CA) and shock are at increased risk of mortality, even when stratified according to shock severity. We sought to determine whether the presence of ventricular fibrillation (VF) modified the relationship between CA and mortality in cardiac intensive care unit (CICU) patients.
We retrospectively analyzed unique Mayo Clinic CICU patients admitted between 2007 and 2015. Society for Cardiovascular Angiography and Intervention (SCAI) shock stages A through E were classified at admission. Hospital mortality in each SCAI shock stage was stratified by the presence of CA, VF CA, or non-VF CA.
We included 9,898 patients with a mean age of 68 years (38% females). CA was present in 12%, including 53% with VF CA and 47% with non-VF CA. Hospital mortality was higher in patients with CA compared to patients without CA (34% vs. 6%; adjusted odds ratio [OR] = 3.1, 95% CI [2.4, 4.0], p < .001), and patients with non-VF CA had higher hospital mortality than patients with VF CA (44% vs. 25%; adjusted OR = 2.1, 95% CI [1.4, 3.0], p < .001). After adjustment, patients with any CA or non-VF CA had higher hospital mortality at each SCAI stage, except stage E (all other p < .05), whereas patients with VF CA did not (all p > .1).
CA rhythm modifies the relationship between CA and mortality in CICU patients, when accounting for coma, shock, and organ failure. Outcome studies examining CA in patients with cardiogenic shock need to account for important differences such as CA rhythm.
合并心搏骤停（CA）和休克的患者死亡率增加，即使根据休克严重程度分层也是如此。我们试图确定心室颤动（VF）的存在是否改变了心脏重症监护病房（CICU）患者 CA 与死亡率之间的关系。
我们回顾性分析了 2007 年至 2015 年期间梅奥诊所 CICU 收治的独特患者。入院时根据Society for Cardiovascular Angiography and Intervention（SCAI）休克阶段 A 至 E 进行分类。在每个 SCAI 休克阶段，根据 CA 的存在、VF CA 或非 VF CA 分层医院死亡率。
我们纳入了 9898 例平均年龄为 68 岁（38%为女性）的患者。CA 的发生率为 12%，其中 53%为 VF CA，47%为非 VF CA。与无 CA 的患者相比，CA 患者的住院死亡率更高（34% vs. 6%；调整后的优势比 [OR] = 3.1，95%CI [2.4, 4.0]，p <.001），而非 VF CA 患者的住院死亡率高于 VF CA 患者（44% vs. 25%；调整后的 OR = 2.1，95%CI [1.4, 3.0]，p <.001）。调整后，除 SCAI 阶段 E 外（所有其他 p <.05），任何 CA 或非 VF CA 的患者在每个 SCAI 阶段的住院死亡率均较高，而 VF CA 的患者则没有（所有 p >.1）。
在考虑昏迷、休克和器官衰竭的情况下，CA 节律改变了 CICU 患者 CA 与死亡率之间的关系。在研究心源性休克患者的 CA 时，需要考虑 CA 节律等重要差异。
