Wolfe Heather A, Morgan Ryan W, Sutton Robert M, Reeder Ron W, Meert Kathleen L, Pollack Murray M, Yates Andrew R, Berger John T, Newth Christopher J, Carcillo Joseph A, McQuillen Patrick S, Harrison Rick E, Moler Frank W, Carpenter Todd C, A Notterman Daniel, Dean J Michael, Nadkarni Vinay M, Berg Robert A
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
Resuscitation. 2020 Aug;153:209-216. doi: 10.1016/j.resuscitation.2020.06.027. Epub 2020 Jul 1.
Patients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime.
This is a secondary analysis of data collected from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study. Pediatric or Pediatric Cardiac Intensive Care Unit patients who received chest compressions for ≥1 min and who had invasive arterial BP monitoring were enrolled. Nighttime was defined as 11:00PM to 6:59AM and daytime as 7:00AM until 10:59PM. Primary outcome was attainment of DBP ≥ 25 mmHg in infants <1 year and ≥30 mmHg in older children. Secondary outcomes were mean DBP, ROSC, and survival to hospital discharge. Univariable and multivariate analyses evaluated the relationships between time (nighttime vs. daytime) and outcomes.
Between July 1, 2013 and June 30, 2016, 164 arrests met all inclusion/exclusion criteria: 45(27%) occurred at nighttime and 119(73%) during daytime. Average DBPs achieved were not different between groups (DBP: nighttime 28.3 mmHg[25.3, 36.5] vs. daytime 29.6 mmHg[21.8, 38.0], p = 0.64). Relative risk of DBP threshold met during nighttime vs. daytime was 1.27, 95%CI [0.80, 1.98], p = 0.30. There was no significant nighttime vs. daytime difference in ROSC (28/45[62%] vs. 84/119[71%] p = 0.35) or survival to hospital discharge (16/45[36%] vs. 61/119[51%], p = 0.08).
In this cohort of pediatric ICU patients with IHCA, there was no significant difference in DBP during CPR between nighttime and daytime.
与白天相比，住院期间发生心脏骤停（IHCA）的患者若在夜间发生骤停，则存活可能性更低。舒张压（DBP）作为衡量胸外按压质量的指标，与小儿IHCA的存活情况相关。我们假设，与白天相比，夜间进行IHCA心肺复苏时的DBP更低。
这是一项对从儿科心肺复苏质量强化护理研究中收集的数据进行的二次分析。纳入了在儿科或小儿心脏重症监护病房接受胸外按压≥1分钟且进行有创动脉血压监测的患者。夜间定义为晚上11点至上午6点59分，白天定义为上午7点至晚上10点59分。主要结局是1岁以下婴儿的DBP≥25 mmHg，年龄较大儿童的DBP≥30 mmHg。次要结局是平均DBP、自主循环恢复（ROSC）和存活至出院。单变量和多变量分析评估了时间（夜间与白天）与结局之间的关系。
在2013年7月1日至2016年6月30日期间，164例心脏骤停符合所有纳入/排除标准：45例（27%）在夜间发生，119例（73%）在白天发生。两组达到的平均DBP无差异（DBP：夜间28.3 mmHg[25.3, 36.5]，白天29.6 mmHg[21.8, 38.0]，p = 0.64）。夜间与白天达到DBP阈值的相对风险为1.27，95%可信区间[0.80, 1.98]，p = 0.30。ROSC（28/45[62%]对84/119[71%]，p = 0.35）或存活至出院（16/45[36%]对61/119[51%]）在夜间与白天之间无显著差异，p = 0.08。
在这组患有IHCA的儿科重症监护病房患者中，夜间与白天心肺复苏期间的DBP无显著差异。
