Zelop Carolyn M, Shaw Richard E, Edelson Dana P, Lipman Steven S, Mhyre Jill M, Arafeh Julie, Jeejeebhoy Farida M, Einav Sharon
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA.
Valley Health, Research and Statistical Consultant, The Valley Hospital, 223 N Van Dien Ave., Ridgewood, NJ, 07450, USA.
Resuscitation. 2021 Jul;164:40-45. doi: 10.1016/j.resuscitation.2021.04.027. Epub 2021 May 15.
Maternal mortality has risen in the United States during the 21st century. Factors influencing outcome of maternal cardiac arrest (MCA) remain largely unexplored.
We sought to further elucidate the factors affecting maternal death from in-hospital (IH) MCA.
Our query of the American Heart Association's GWTG®-Resuscitation voluntary registry from 2000-2017 revealed 561 index cases of IH MCA with complete outcome data. Logistic regression was performed using hospital death as the primary outcome and included variables with a p value = 0.1 or less based upon univariate analysis. Age, race, year of arrest, pre-existing conditions, first documented pulseless rhythm and location of arrest were used in the model. Sensitivity analyses and assessment of variable interaction were also performed to test model stability. Institutional review deemed this research exempt from ethical approval.
Among 561 cases of MCA, 57.2% (321/561) did not survive to hospital discharge. IH death was not associated with maternal age, race and year of event. In the final model, IH death was significantly associated with pre-arrest hypotension/hypoperfusion (OR = 1.80 (95% CI, 1.16-2.79); p = 0.009). The occurrence of MCA outside of the delivery suite (referent group) or operating room was associated with a significantly higher risk of death: ICU/Post-Anesthesia Care Unit (PACU) (OR = 3.32 (95% CI, 2.00-5.52); p < 0.001) and ER/other (OR = 1.89 (95% CI, 1.15-3.11); p = 0.012). While MCA cases with a shockable vs. non-shockable first documented pulseless rhythm had similar outcomes, those with an indeterminate rhythm were less likely to die, (OR = 0.41(95% CI, 0.20-0.84); p = 0.014). In a sensitivity analysis, removal of the indeterminate group did not alter outcomes regarding first documented pulseless rhythm or arrest location. Area under the curve for the final model was 0.715 (95% CI 0.673-0.757).
Our study identified several novel factors associated with IH death of our MCA cohort. More research is required to further understand the pathophysiologic dynamics affecting outcomes of IH MCA in this unique population.
21世纪美国孕产妇死亡率有所上升。影响孕产妇心脏骤停（MCA）结局的因素在很大程度上仍未得到充分研究。
我们试图进一步阐明影响院内（IH）MCA导致孕产妇死亡的因素。
我们对美国心脏协会2000 - 2017年的GWTG®-复苏自愿登记数据库进行查询，发现561例具有完整结局数据的IH MCA索引病例。以医院死亡作为主要结局进行逻辑回归分析，并纳入单因素分析中p值≤0.1的变量。模型中使用了年龄、种族、心脏骤停年份、既往疾病、首次记录的无脉心律以及心脏骤停位置。还进行了敏感性分析和变量交互作用评估以检验模型稳定性。机构审查认为本研究无需伦理批准。
在561例MCA病例中，57.2%（321/561）未存活至出院。IH死亡与孕产妇年龄、种族和事件发生年份无关。在最终模型中，IH死亡与心脏骤停前低血压/低灌注显著相关（比值比[OR]=1.80[95%置信区间（CI），1.16 - 2.79]；p = 0.009）。在产房（参照组）或手术室之外发生的MCA与显著更高的死亡风险相关：重症监护病房/麻醉后护理单元（PACU）（OR = 3.32[95% CI，2.00 - 5.52]；p < 0.001）以及急诊室/其他区域（OR = 1.89[95% CI，1.15 - 3.11]；p = 0.012）。虽然首次记录的无脉心律为可电击与不可电击的MCA病例结局相似，但心律不确定的病例死亡可能性较小（OR = 0.41[95% CI，0.20 - 0.84]；p = 0.014）。在敏感性分析中，去除心律不确定组并未改变首次记录的无脉心律或心脏骤停位置的结局。最终模型的曲线下面积为0.715（95% CI 0.673 - 0.757）。
我们的研究确定了几个与我们的MCA队列中IH死亡相关的新因素。需要更多研究来进一步了解影响这一独特人群中IH MCA结局的病理生理动态变化。
