Intensive Care National Audit & Research Centre, London, UK.
Liverpool Hospital, Sydney, Australia.
Clin Med (Lond). 2020 May;20(3):319-323. doi: 10.7861/clinmed.2019-0454.
The aim was to determine if the 17 June 2014 Tracey judgment regarding 'do not attempt cardiopulmonary resuscitation' decisions led to increases in the rate of in-hospital cardiac arrests resulting in a resuscitation attempt (IHCA) and/or proportion of resuscitation attempts deemed futile.
Using UK National Cardiac Arrest Audit data, the IHCA rate and proportion of resuscitation attempts deemed futile were compared for two periods (pre-judgment (01 July 2012 - 16 June 2014, inclusive) and post-judgment (01 July 2014 - 30 June 2016, inclusive)) using interrupted time series analyses.
A total of 43,109 IHCAs (115 hospitals) were analysed. There were fewer IHCAs post- than pre-judgment (21,324 vs 21,785, respectively). The IHCA rate was declining over time before the judgment but there was an abrupt and statistically significant increase in the period immediately following the judgment (p<0.001). This was not sustained post-judgment. The proportion of resuscitation attempts deemed futile was smaller post-judgment than pre-judgment (8.2% vs 14.9%, respectively). The rate of attempts deemed futile decreased post-judgment (p<0.001).
The IHCA rate increased immediately after the Tracey judgment while the proportion of resuscitation attempts deemed futile decreased. The precise mechanisms for these changes are unclear.
本研究旨在确定特雷西案（Tracey judgment）中关于“不进行心肺复苏”的决定是否会导致院内心搏骤停（in-hospital cardiac arrest，IHCA）发生率增加，以及复苏尝试（resuscitation attempt）的比例是否会增加。
本研究使用英国国家心脏骤停审计数据，采用中断时间序列分析，比较了两个时间段（判决前（2012 年 7 月 1 日至 2014 年 6 月 16 日，含首尾日期）和判决后（2014 年 7 月 1 日至 2016 年 6 月 30 日，含首尾日期））的 IHCA 发生率和被认为无效的复苏尝试比例。
共分析了 43109 例 IHCA（115 家医院）。判决后 IHCA 例数较判决前减少（分别为 21324 例和 21785 例）。在判决前，IHCA 发生率呈下降趋势，但在判决后立即出现了突然且具有统计学意义的上升（p<0.001）。但这一趋势在判决后并未持续。判决后被认为无效的复苏尝试比例较判决前小（分别为 8.2%和 14.9%）。判决后被认为无效的复苏尝试率下降（p<0.001）。
特雷西案判决后，IHCA 发生率立即上升，而被认为无效的复苏尝试比例下降。这些变化的确切机制尚不清楚。
