Thorén Anna, Rawshani Araz, Herlitz Johan, Engdahl Johan, Kahan Thomas, Gustafsson Linnéa, Djärv Therese
Department of Medicine, Solna, Centre for Resuscitation Science, Karolinska Institute, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, Danderyd University Hospital Corp., SE-182 88 Stockholm, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, SE-405 30 Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden.
Resuscitation. 2020 May;150:130-138. doi: 10.1016/j.resuscitation.2020.03.002. Epub 2020 Mar 21.
ECG-monitoring is a strong predictor for 30-days survival after in-hospital cardiac arrest (IHCA). The aim of the study is to investigate factors influencing the effect of ECG-monitoring on 30-days survival after IHCA and elements of importance in everyday clinical practice regarding whether patients are ECG-monitored prior to IHCA.
In all, 19.225 adult IHCAs registered in the Swedish Registry for Cardiopulmonary Resuscitation (SRCR) were included. Cox-adjusted survival curves were computed to study survival post IHCA. Logistic regression was used to study the association between 15 predictors and 30-days survival. Using logistic regression we calculated propensity scores (PS) for ECG-monitoring; the PS was used as a covariate in a logistical regression estimating the association between ECG-monitoring and 30-days survival. Gradient boosting was used to study the relative importance of all predictors on ECG-monitoring.
Overall 30-days survival was 30%. The ECG-monitored group (n = 10.133, 52%) had a 38% lower adjusted mortality (HR 0.62 95% CI 0.60-0.64). We observed tangible variations in ECG-monitoring ratio at different centres. The predictors of most relative influence on ECG-monitoring in IHCA were location in hospital and geographical localization.
ECG-monitoring in IHCA was associated to a 38% lower adjusted mortality, despite this finding only every other IHCA patient was monitored. The significant variability in the frequency of ECG-monitoring in IHCA at different centres needs to be evaluated in future research. Guidelines for in-hospital ECG-monitoring could contribute to an improved identification and treatment of patients at risk, and possibly to an improved survival.
心电图监测是院内心脏骤停（IHCA）后30天生存率的有力预测指标。本研究的目的是调查影响心电图监测对IHCA后30天生存率效果的因素，以及在日常临床实践中关于IHCA前患者是否进行心电图监测的重要因素。
总共纳入了瑞典心肺复苏登记处（SRCR）登记的19225例成年IHCA患者。计算Cox调整生存曲线以研究IHCA后的生存率。采用逻辑回归研究15个预测因素与30天生存率之间的关联。使用逻辑回归计算心电图监测的倾向得分（PS）；PS作为协变量用于逻辑回归，估计心电图监测与30天生存率之间的关联。采用梯度提升法研究所有预测因素对心电图监测的相对重要性。
总体30天生存率为30%。接受心电图监测的组（n = 10133，52%）调整后的死亡率降低了38%（HR 0.62，95%CI 0.60 - 0.64）。我们观察到不同中心的心电图监测率存在明显差异。在IHCA中，对心电图监测相对影响最大的预测因素是医院位置和地理定位。
尽管在IHCA中只有每隔一例患者接受监测，但心电图监测与调整后死亡率降低38%相关。不同中心在IHCA中进行心电图监测频率的显著差异需要在未来研究中进行评估。院内心电图监测指南可能有助于更好地识别和治疗高危患者，并可能提高生存率。
