Department of Anaesthesia, Austin Hospital, Heidelberg, VIC, Australia.
Department of Intensive Care Medicine, Calvary Hospital, Canberra, ACT, Australia.
Crit Care Med. 2021 Jun 1;49(6):901-911. doi: 10.1097/CCM.0000000000004950.
To investigate the incidence, characteristics, and outcomes of in-hospital cardiac arrest in patients with coronavirus disease 2019 and to describe the characteristics and outcomes for patients with in-hospital cardiac arrest within the ICU, compared with non-ICU patients with in-hospital cardiac arrest. Finally, we evaluated outcomes stratified by age.
A systematic review of PubMed, EMBASE, and preprint websites was conducted between January 1, 2020, and December 10, 2020. Prospective Register of Systematic Reviews identification: CRD42020203369.
Studies reporting on consecutive in-hospital cardiac arrest with a resuscitation attempt among patients with coronavirus disease 2019.
Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines. Discrepancies were resolved by consensus or through an independent third reviewer.
Eight studies reporting on 847 in-hospital cardiac arrest were included. In-hospital cardiac arrest incidence varied between 1.5% and 5.8% among hospitalized patients and 8.0-11.4% among patients in ICU. In-hospital cardiac arrest occurred more commonly in older male patients. Most initial rhythms were nonshockable (83.9%, [asystole = 36.4% and pulseless electrical activity = 47.6%]). Return of spontaneous circulation occurred in 33.3%, with a 91.7% in-hospital mortality. In-hospital cardiac arrest events in ICU had higher incidence of return of spontaneous circulation (36.6% vs 18.7%; p < 0.001) and relatively lower mortality (88.7% vs 98.1%; p < 0.001) compared with in-hospital cardiac arrest in non-ICU locations. Patients greater than or equal to 60 years old had significantly higher in-hospital mortality than those less than 60 years (93.1% vs 87.9%; p = 0.019).
Approximately, one in 20 patients hospitalized with coronavirus disease 2019 received resuscitation for an in-hospital cardiac arrest. Hospital survival after in-hospital cardiac arrest within the ICU was higher than non-ICU locations and seems comparable with prepandemic survival for nonshockable rhythms. Although the data provide guidance surrounding prognosis after in-hospital cardiac arrest, it should be interpreted cautiously given the paucity of information surrounding treatment limitations and resource constraints during the pandemic. Further research is into actual causative mechanisms is needed.
调查 2019 年冠状病毒病患者院内心搏骤停的发生率、特征和结局，并描述 ICU 内院内心搏骤停患者与非 ICU 内院内心搏骤停患者的特征和结局。最后，我们按年龄进行了分层结局评估。
对 2020 年 1 月 1 日至 2020 年 12 月 10 日期间的 PubMed、EMBASE 和预印本网站进行了系统评价。系统评价注册处识别号：CRD42020203369。
报告了 2019 年冠状病毒病连续发生院内心搏骤停且对患者进行复苏尝试的研究。
两名作者独立进行了研究选择和数据提取。采用纽卡斯尔-渥太华量表评估研究质量。根据系统评价和荟萃分析首选报告项目指南进行数据综合。通过共识或独立的第三位评审员解决差异。
纳入了 8 项报告了 847 例院内心搏骤停的研究。住院患者中心搏骤停的发生率为 1.5%至 5.8%，而 ICU 患者中的发生率为 8.0%至 11.4%。院内心搏骤停更常发生在年龄较大的男性患者中。大多数初始节律是非可电击性的（83.9%[心搏停止=36.4%和无脉电活动=47.6%]）。自主循环恢复率为 33.3%，院内死亡率为 91.7%。与非 ICU 位置相比，ICU 中的院内心搏骤停事件具有更高的自主循环恢复率（36.6%比 18.7%；p<0.001）和相对较低的死亡率（88.7%比 98.1%；p<0.001）。年龄大于或等于 60 岁的患者院内死亡率明显高于年龄小于 60 岁的患者（93.1%比 87.9%；p=0.019）。
大约每 20 名住院治疗 2019 年冠状病毒病的患者中就有 1 名接受了院内心搏骤停复苏。与非 ICU 位置相比，ICU 内发生院内心搏骤停后的院内存活率更高，并且与非电击性节律的大流行前存活率相当。尽管这些数据为院内心搏骤停后的预后提供了指导，但鉴于大流行期间有关治疗限制和资源限制的信息有限，应谨慎解读。需要进一步研究实际的因果机制。
