院内与院外心脏骤停：患者特征与生存。
In-Hospital vs. Out-of-Hospital Cardiac Arrest: Patient Characteristics and Survival.
机构信息
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
Copenhagen Emergency Medical Services, Capital Region of Denmark, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark.
出版信息
Resuscitation. 2021 Jan;158:157-165. doi: 10.1016/j.resuscitation.2020.11.016. Epub 2020 Nov 19.
BACKGROUND
Cardiac arrests are often categorized into two separate groups depending on the location of the arrest: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, few studies have compared the two groups directly. The aim of this study was to compare patient characteristics, cardiac arrest characteristics, and outcomes for IHCA and OHCA patients.
METHODS
Data on IHCA and OHCA in Denmark were obtained from two nationwide, prospective registries. All adult (≥18 years old) patients with index IHCA or OHCA from January 1, 2017 to December 31, 2018 were included. Supplementary information on outcomes, hospitalizations, and chronic diseases came from additional national registries. The primary outcome was 30-day survival and secondary outcomes were return of spontaneous circulation (ROSC) and 1-year survival.
RESULTS
The study included 3501 patients with IHCA and 8846 patients with OHCA. The two groups were similar in demographics, most comorbidities, and initial cardiac arrest rhythm. In the unadjusted analysis, IHCA was associated with increased survival to 30 days compared to OHCA (risk ratio [RR] = 1.41; 95% CI, 1.30; 1.54) and 1 year (RR = 1.46; 95% CI, 1.33; 1.61). Adjusting for age, sex, and comorbidities did not change the RR substantially. When cardiac arrest characteristics were added to the model, the RR decreased from 1.51 (95% CI, 1.39; 1.65) to 1.06 (95% CI, 0.93; 1.20) for survival to 30 days and from 1.66 (95% CI, 1.50; 1.84) to 1.09 (95% CI, 0.94; 1.26) for survival to 1 year. In all subgroup analyses based on cardiac arrest characteristics (e.g. witnessed status), the association between location and outcome was substantially mitigated compared to the primary analyses.
CONCLUSIONS
In this large, national study, we found that IHCA and OHCA patients were remarkably similar in demographics and most comorbidities. IHCA patients had better outcomes compared to OHCA patients, although these differences disappeared when comparing patients with similar cardiac arrest characteristics.
背景
心脏骤停通常根据发生地点分为两类：院内心脏骤停（IHCA）和院外心脏骤停（OHCA）。尽管有这种区分，但很少有研究直接比较这两组。本研究旨在比较 IHCA 和 OHCA 患者的患者特征、心脏骤停特征和结局。
方法
从丹麦两个全国性前瞻性登记处获得 IHCA 和 OHCA 数据。纳入 2017 年 1 月 1 日至 2018 年 12 月 31 日期间索引 IHCA 或 OHCA 的所有成年（≥18 岁）患者。结局、住院和慢性病的补充信息来自其他国家登记处。主要结局为 30 天生存率，次要结局为自主循环恢复（ROSC）和 1 年生存率。
结果
该研究纳入 3501 例 IHCA 患者和 8846 例 OHCA 患者。两组在人口统计学特征、大多数合并症和初始心脏骤停节律方面相似。在未调整分析中，与 OHCA 相比，IHCA 与 30 天生存率增加相关（风险比[RR] 1.41；95%CI，1.30；1.54）和 1 年生存率增加相关（RR 1.46；95%CI，1.33；1.61）。调整年龄、性别和合并症后，RR 变化不大。当将心脏骤停特征纳入模型时，30 天生存率的 RR 从 1.51（95%CI，1.39；1.65）降至 1.06（95%CI，0.93；1.20），1 年生存率的 RR 从 1.66（95%CI，1.50；1.84）降至 1.09（95%CI，0.94；1.26）。在基于心脏骤停特征的所有亚组分析中（例如目击状态），与主要分析相比，位置与结局之间的关联大大减轻。
结论
在这项大型全国性研究中，我们发现 IHCA 和 OHCA 患者在人口统计学特征和大多数合并症方面非常相似。与 OHCA 患者相比，IHCA 患者的结局更好，尽管在比较具有相似心脏骤停特征的患者时，这些差异消失了。
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