英格兰儿科重症监护病房危重病儿童心肺复苏的流行病学:一项多中心回顾性队列研究。

Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study.

机构信息

Paediatric Intensive Care Leeds Children's Hospital United Kingdom.

School of Medicine University of Leeds United Kingdom.

出版信息

J Am Heart Assoc. 2021 May 4;10(9):e018177. doi: 10.1161/JAHA.120.018177. Epub 2021 Apr 26.

Abstract

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02-2.61), age <1 year (OR, 1.84; 95% CI, 1.65-2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042-1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012-1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16-23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91-3.98). Children from Black (OR, 1.68; 95% CI, 1.36-2.07) and Asian (OR, 1.49; 95% CI, 1.28-1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.

摘要

背景 心肺骤停是儿科重症监护病房(PICU)患者死亡和发病的主要原因。了解心肺复苏术(CPR)的流行病学和危险因素可以为国家质量改进计划提供信息。

方法和结果 本研究使用英国儿科重症监护审核网络数据库前瞻性收集的数据进行回顾性队列分析。该儿科重症监护审核网络包含英国所有 PICU 入院患者的数据。我们确定了在英格兰 23 家 PICU 接受心肺复苏术(CPR)的儿童。分析了 CPR 的发生率和相关因素。使用逻辑回归估计关联的大小和精度。5 年来,68114 例入院患者中有 2.2%接受了 CPR,发生率为每 1000 个床位日 4.9 例。心血管诊断(比值比[OR],2.30;95%置信区间[CI],2.02-2.61)、年龄<1 岁(OR,1.84;95%CI,1.65-2.04)、入院时小儿死亡率 2 评分(OR,1.045;95%CI,1.042-1.047)和住院时间延长(OR,1.013;95%CI,1.012-1.014)与接受 CPR 的几率增加相关。我们还发现,与心肺复苏术相关的风险更高的情况包括先前入院时发生心脏骤停(OR,20.69;[95%CI,18.16-23.58)和患有心脏疾病的患儿被收入非心脏 PICU(OR,2.75;95%CI,1.91-3.98)。与白人儿童相比,来自黑人(OR,1.68;95%CI,1.36-2.07)和亚裔(OR,1.49;95%CI,1.28-1.74)种族/族裔背景的儿童在 PICU 中接受 CPR 的风险更高。

结论 来自英格兰的这项首次多中心研究提供了进一步研究的基础,并为 PICU 中心脏骤停预防的基准测试和质量改进提供了证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/978d/8200770/dd0fc4fa4543/JAH3-10-e018177-g003.jpg

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