Alnabelsi Talal, Annabathula Rahul, Shelton Julie, Paranzino Marc, Faulkner Sarah Price, Cook Matthew, Dugan Adam J, Nerusu Sethabhisha, Smyth Susan S, Gupta Vedant A
Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States.
College of Medicine, University of Kentucky, Lexington, KY, United States.
Resusc Plus. 2020 Nov 7;4:100039. doi: 10.1016/j.resplu.2020.100039. eCollection 2020 Dec.
Most survivors of an in-hospital cardiac arrest do not leave the hospital alive, and there is a need for a more patient-centered, holistic approach to the assessment of prognosis after an arrest. We sought to identify pre-, peri-, and post-arrest variables associated with in-hospital mortality amongst survivors of an in-hospital cardiac arrest.
This was a retrospective cohort study of patients ≥18 years of age who were resuscitated from an in-hospital arrest at our University Medical Center from January 1, 2013 to September 31, 2016. In-hospital mortality was chosen as a primary outcome and unfavorable discharge disposition (discharge disposition other than home or skilled nursing facility) as a secondary outcome.
925 patients comprised the in-hospital arrest cohort with 305 patients failing to survive the arrest and a further 349 patients surviving the initial arrest but dying prior to hospital discharge, resulting in an overall survival of 29%. 620 patients with a ROSC of greater than 20 min following the in-hospital arrest were included in the final analysis. In a stepwise multivariable regression analysis, recurrent cardiac arrest, increasing age, time to ROSC, higher serum creatinine levels, and a history of cancer were predictors of in-hospital mortality. A history of hypertension was found to exert a protective effect on outcomes. In the regression model including serum lactate, increasing lactate levels were associated with lower odds of survival.
Amongst survivors of in-hospital cardiac arrest, recurrent cardiac arrest was the strongest predictor of poor outcomes with age, time to ROSC, pre-existing malignancy, and serum creatinine levels linked with increased odds of in-hospital mortality.
大多数医院内心脏骤停幸存者未能活着出院，因此需要一种更以患者为中心的整体方法来评估心脏骤停后的预后。我们试图确定与医院内心脏骤停幸存者院内死亡率相关的骤停前、骤停期间和骤停后变量。
这是一项回顾性队列研究，研究对象为2013年1月1日至2016年9月31日在我们大学医学中心从医院内心脏骤停中复苏的18岁及以上患者。将院内死亡率作为主要结局，将不良出院处置（除回家或熟练护理机构以外的出院处置）作为次要结局。
925名患者组成了医院内心脏骤停队列，其中305名患者在心脏骤停后未能存活，另有349名患者在最初的心脏骤停后存活但在出院前死亡，总体生存率为29%。最终分析纳入了620名在医院内心脏骤停后自主循环恢复时间超过20分钟的患者。在逐步多变量回归分析中，反复心脏骤停、年龄增加、自主循环恢复时间、血清肌酐水平升高和癌症病史是院内死亡率的预测因素。发现高血压病史对结局有保护作用。在包括血清乳酸的回归模型中，乳酸水平升高与较低的生存几率相关。
在医院内心脏骤停幸存者中，反复心脏骤停是不良结局的最强预测因素，年龄、自主循环恢复时间、既往恶性肿瘤和血清肌酐水平与院内死亡率增加相关。
