Stankovic Nikola, Høybye Maria, Holmberg Mathias J, Lauridsen Kasper G, Andersen Lars W, Granfeldt Asger
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
Resuscitation. 2021 Jan;158:166-174. doi: 10.1016/j.resuscitation.2020.11.022. Epub 2020 Nov 26.
To identify factors associated with the initial rhythm in patients with in-hospital cardiac arrest and to assess whether potential differences in outcomes based on the initial rhythm can be explained by patient and event characteristics.
Adult patients (≥18 years old) with in-hospital cardiac arrest in 2017 and 2018 were included from the Danish In-Hospital Cardiac Arrest Registry (DANARREST). We used population-based registries to obtain data on comorbidities, cardiac procedures, and medications. Unadjusted and adjusted risk ratios (RRs) for initial rhythm, return of spontaneous circulation (ROSC), and survival were estimated in separate models including an incremental number of prespecified variables.
A total of 3422 patients with in-hospital cardiac arrest were included, of which 639 (19%) had an initial shockable rhythm. Monitored cardiac arrest, witnessed cardiac arrest, and specific cardiac diseases (i.e. ischemic heart disease, dysrhythmias, and valvular heart disease) were associated with initial shockable rhythm. Conversely, higher age, female sex, and specific non-cardiovascular comorbidities (e.g. overweight and obesity, renal disease, and pulmonary cancer) were associated with an initial non-shockable rhythm. Initial shockable rhythm remained strongly associated with increased ROSC (RR = 1.63, 95%CI 1.51-1.76), 30-day survival (RR = 2.31, 95%CI 2.02-2.64), and 1-year survival (RR = 2.36, 95%CI 2.02-2.76) compared to initial non-shockable rhythm in the adjusted analyses.
In this study, specific patient and cardiac arrest characteristics were associated with initial rhythm in patients with in-hospital cardiac arrest. However, differences in patient and cardiac arrest characteristics did not fully explain the association with survival for initial shockable rhythm compared to a non-shockable rhythm.
确定与院内心脏骤停患者初始心律相关的因素，并评估基于初始心律的结局潜在差异是否可由患者和事件特征来解释。
从丹麦院内心脏骤停登记处（DANARREST）纳入2017年和2018年发生院内心脏骤停的成年患者（≥18岁）。我们利用基于人群的登记处获取合并症、心脏手术和用药的数据。在单独模型中估计初始心律、自主循环恢复（ROSC）和生存的未调整及调整风险比（RR），模型中纳入预先设定的变量数量逐步增加。
共纳入3422例院内心脏骤停患者，其中639例（19%）初始心律为可电击心律。监测到的心脏骤停、目击的心脏骤停以及特定心脏病（即缺血性心脏病、心律失常和瓣膜性心脏病）与初始可电击心律相关。相反，高龄、女性以及特定非心血管合并症（如超重和肥胖、肾病和肺癌）与初始不可电击心律相关。在调整分析中，与初始不可电击心律相比，初始可电击心律仍与更高的ROSC（RR = 1.63，95%CI 1.51 - 1.76）、30天生存率（RR = 2.31，95%CI 2.02 - 2.64）和1年生存率（RR = 2.36，95%CI 2.02 - 2.76）密切相关。
在本研究中，特定患者和心脏骤停特征与院内心脏骤停患者的初始心律相关。然而，与不可电击心律相比，患者和心脏骤停特征的差异并未完全解释初始可电击心律与生存之间的关联。
