儿童住院期间心脏骤停后生存结果的种族差异。
Racial disparities in survival outcomes following pediatric in-hospital cardiac arrest.
作者信息
Haskell Sarah E, Girotra Saket, Zhou Yunshu, Zimmerman M Bridget, Del Rios Marina, Merchant Raina M, Atkins Dianne L
机构信息
Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
出版信息
Resuscitation. 2021 Feb;159:117-125. doi: 10.1016/j.resuscitation.2020.12.018. Epub 2021 Jan 2.
BACKGROUND
Among adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA are unknown.
METHODS
Using 2000-2017 data from the American Heart Association Get With the Guidelines-Resuscitation® registry, we identified children >24 h and <18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge, return of spontaneous circulation (ROSC), and favorable neurologic outcome at discharge.
RESULTS
Overall, 2940 pediatric patients (898 black, 2042 white) at 224 hospitals with IHCA were included. The mean age was 3.0 years, 57% were male and 16% had an initial shockable rhythm. Age, sex, interventions in place at the time of arrest and cardiac arrest characteristics did not differ significantly by race. The overall survival to discharge was 36.9%, return of spontaneous circulation (ROSC) was 73%, and favorable neurologic survival was 20.8%. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; risk-adjusted OR 0.79, 95% CI 0.67-0.94, P = 0.016), black race was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; risk-adjusted OR 0.96, 95% CI 0.80-1.15, P = 0.68) or favorable neurologic outcome (18.7% in blacks vs. 21.8% in whites, risk-adjusted OR 0.98, 95% CI 0.80-1.20, p = 0.85).
CONCLUSIONS
In contrast to adults, we did not find evidence for racial differences in survival outcomes following IHCA among children.
背景
在院内心脏骤停（IHCA）的成年患者中，黑人患者的总体生存率低于白人患者。关于小儿IHCA生存的种族差异的数据尚不清楚。
方法
利用美国心脏协会“遵循指南-复苏”注册中心2000 - 2017年的数据，我们确定了年龄大于24小时且小于18岁、因初始无脉心律而发生IHCA的儿童。我们使用广义估计方程来研究黑人种族与出院生存、自主循环恢复（ROSC）以及出院时良好神经功能结局之间的关联。
结果
总体上，224家医院的2940例小儿IHCA患者（898例黑人，2042例白人）被纳入研究。平均年龄为3.0岁，57%为男性，16%初始心律可电击复律。年龄、性别、心脏骤停时的干预措施以及心脏骤停特征在种族间无显著差异。出院总体生存率为36.9%，自主循环恢复（ROSC）率为73%，良好神经功能生存率为20.8%。尽管与白人患者相比，黑人种族的ROSC率较低（黑人69.5% vs. 白人74.6%；风险调整OR 0.79，95% CI 0.67 - 0.94，P = 0.016），但黑人种族与出院生存（黑人34.7% vs. 白人37.8%；风险调整OR 0.96，95% CI 0.80 - 1.15，P = 0.68）或良好神经功能结局（黑人18.7% vs. 白人21.8%，风险调整OR 0.98，95% CI 0.80 - 1.20，P = 0.85）无关。
结论
与成人不同，我们未发现小儿IHCA后生存结局存在种族差异的证据。
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