Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
BMJ Open. 2020 Mar 19;10(3):e032264. doi: 10.1136/bmjopen-2019-032264.
To study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.
A retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).
The SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.
The study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).
Primary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.
In the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).
In-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.
研究因吸入性肺炎导致院内心搏骤停（IHCA）患者的特征和结局。
基于瑞典心肺复苏注册中心（SRCR）数据的回顾性观察研究。
SRCR 是一个覆盖瑞典所有医院 96%的全国性质量登记处。参与的医院规模从二级医院到大学医院不等。
本研究纳入了 2008 年至 2017 年期间在 SRCR 登记的患者。我们比较了因吸入性肺炎导致 IHCA 的患者（n=127）与因其他原因导致呼吸衰竭而导致 IHCA 的患者（n=2197）。
主要结局为 30 天生存率。次要结局为持续自主循环恢复（ROSC），定义为现场 ROSC 并活着被送入重症监护病房。
在吸入组中，80%的 IHCA 发生在普通病房，而在呼吸衰竭组中为 63.6%（p<0.001）。与呼吸衰竭组相比，吸入组患者在心脏骤停时接受监测的可能性较小（18.5% vs 38%，p<0.001），持续 ROSC 的发生率也显著较低（36.5% vs 51.6%，p=0.001）。与呼吸衰竭组相比，未调整的 30 天生存率为 7.9% vs 18.0%，p=0.024。在倾向评分分析（包括变量；年份、年龄、性别、心脏骤停位置、初始心律、心电图监测、目击性昏迷和既往癌症、心肌梗死或心力衰竭病史）中，30 天生存率的 OR 为 0.46（95%CI 0.19 至 0.94）。
在未接受监测的患者中，因吸入性肺炎导致的 IHCA 更常发生在普通病房。与因其他原因导致的呼吸衰竭所致 IHCA 相比，这些患者的 30 天生存率较低。
