Chen Chao-Tung, Wang Pei-Ming, Wu Chao-Hsin, Wei Chih-Wei, Huang Tai-Lin
Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Emergency Center of Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Emerg Med Int. 2021 Oct 25;2021:9138449. doi: 10.1155/2021/9138449. eCollection 2021.
In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED.
Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems.
In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5-1.8). The aOR (CI) in the five etiologies was 1.3 (1.1-1.6) for hypoxia, 1.8 (1.6-2.1) for cardiac cause, 1.3 (0.98-1.7) for bleeding, 1.3 (1.03-1.6) for sepsis, and 1.9 (1.5-2.1) for other metabolic problems.
More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.
在急诊科（ED），早期识别有心脏骤停风险的患者至关重要，尤其是在过度拥挤的情况下。休克指数（SI）定义为心率与收缩压之比。它是一种用于预测危重病患者和受伤患者预后的工具。在本研究中，我们探讨了急诊科中SI与心脏骤停之间的关系。
根据分诊生命体征，将在急诊科发生心脏骤停的患者分为两组，SI≥0.9组和<0.9组。分析了SI≥0.9与五种不同心脏骤停病因（包括缺氧、心脏病因、出血、败血症和其他代谢问题）的院内死亡率之间的关联。
共有3313例患者在急诊科发生心脏骤停。其中，1909例（57.6%）的SI≥0.9。五种病因中SI≥0.9的发生率分别为43.5%（缺氧）、58.1%（心脏病因）、56.1%（出血）、58.0%（败血症）和65.5%（其他代谢问题）。SI与院内死亡率相关（调整优势比（aOR），1.6；95%置信区间（CI），1.5 - 1.8）。五种病因的aOR（CI）分别为：缺氧1.3（1.1 - 1.6）、心脏病因1.8（1.6 - 2.1）、出血1.3（0.98 - 1.7）、败血症1.3（1.03 - 1.6）、其他代谢问题1.9（1.5 - 2.1）。
在急诊科发生心脏骤停的患者中，超过一半的患者SI≥0.9。SI还与急诊科心脏骤停后的院内死亡率相关。SI可作为一种筛查工具，用于识别急诊科有心脏骤停风险的患者，以及急诊科心脏骤停患者死亡率的预测指标。
