Heaney Jonathan, Paul Eldho, Pilcher David, Lin Caleb, Udy Andrew, Young Paul J
Department of Neurosurgery, Wellington Hospital, Wellington, New Zealand.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Crit Care Resusc. 2020 Sep;22(3):237-244. doi: 10.1016/S1441-2772(23)00391-5.
To describe the characteristics and outcomes of adults with a subarachnoid haemorrhage (SAH) admitted to Australian and New Zealand intensive care units (ICUs) with a cardiac arrest in the preceding 24 hours.
Retrospective cohort study.
Study data from 144 Australian and New Zealand ICUs were obtained from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database.
A total of 439 of 11 047 (3.9%) patients admitted to an ICU with a SAH had a documented cardiac arrest in the 24 hours preceding their ICU admission. The mean age of patients with SAH and a preceding cardiac arrest was 55.3 years (SD, 13.7) and 251 of 439 (57.2%) were female.
The primary outcome of interest was in-hospital mortality. Key secondary outcomes were ICU mortality, ICU and hospital lengths of stay, the proportion of patients discharged home.
SAH patients with a history of cardiac arrest preceding ICU admission had a higher mortality rate (81.5% 23.3%; < 0.0001) and a lower rate of discharge home (4.6% 37.0%; < 0.0001) compared with patients with SAH who did not have a cardiac arrest. Among patients with SAH who had a cardiac arrest and survived, 20 of 81 (24.7%) were discharged home. In SAH patients with cardiac arrest, having a GCS of 3, the Australian and New Zealand Risk of Death score, and being admitted to ICU for palliative care or organ donation were significant predictors of in-hospital death.
Almost one in five SAH patients who had a documented cardiac arrest in the 24 hours preceding ICU admission to an Australian and New Zealand ICU survived to hospital discharge, with around a quarter of these survivors discharged home. The neurological outcomes of these patients are uncertain, and understanding the burden of disability in survivors is an important area for further research.
描述在澳大利亚和新西兰重症监护病房（ICU）住院的蛛网膜下腔出血（SAH）成年患者的特征及预后，这些患者在入院前24小时内发生过心脏骤停。
回顾性队列研究。
研究数据来自澳大利亚和新西兰重症监护学会结局与资源评估中心成人患者数据库，该数据库涵盖了144家澳大利亚和新西兰的ICU。
在11047名因SAH入住ICU的患者中，共有439名（3.9%）在入住ICU前24小时内有心脏骤停记录。SAH且此前有心脏骤停的患者平均年龄为55.3岁（标准差13.7），439名患者中有251名（57.2%）为女性。
主要关注的结局是院内死亡率。关键次要结局包括ICU死亡率、ICU住院时间和住院时间、出院回家患者的比例。
与没有心脏骤停的SAH患者相比，入住ICU前有心脏骤停病史的SAH患者死亡率更高（81.5%对23.3%；P<0.0001），出院回家率更低（4.6%对37.0%；P<0.0001）。在有心脏骤停且存活的SAH患者中，81名中有20名（24.7%）出院回家。在有心脏骤停的SAH患者中，格拉斯哥昏迷量表（GCS）评分为3分、澳大利亚和新西兰死亡风险评分以及因姑息治疗或器官捐献入住ICU是院内死亡的重要预测因素。
在澳大利亚和新西兰ICU入院前24小时内有心脏骤停记录的SAH患者中，近五分之一存活至出院，其中约四分之一的幸存者出院回家。这些患者的神经学结局尚不确定，了解幸存者的残疾负担是进一步研究的重要领域。
