Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel, Lübeck, Germany.
Clin Res Cardiol. 2023 Feb;112(2):258-269. doi: 10.1007/s00392-022-02084-1. Epub 2022 Aug 17.
In-hospital cardiac arrest (IHCA) is acutely life-threatening and remains associated with high mortality and morbidity. Identifying predictors of mortality after IHCA would help to guide acute therapy.
We determined patient characteristics and independent predictors of 30-day in-hospital mortality, neurological outcome, and discharge/referral pathways in patients experiencing IHCA in a large tertiary care hospital between January 2014 and April 2017. Multivariable Cox regression model was fitted to assess predictors of outcomes.
A total of 368 patients with IHCA were analysed (median age 73 years (interquartile range 65-78), 123 (33.4%) women). Most patients (45.9%) had an initial non-shockable rhythm and shockable rhythms were found in 20.9%; 23.6% of patients suffered from a recurrent episode of cardiac arrest. 172/368 patients died within 30 days (46.7%). Of 196/368 patients discharged alive after IHCA, the majority (72.9%, n = 143) had a good functional neurological outcome (modified Rankin Scale ≤ 3 points). In the multivariable analysis, return of spontaneous circulation without mechanical circulatory support (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.21-0.64), invasive coronary angiography and/or percutaneous intervention (HR 0.56, 95% CI 0.34-0.92), and antibiotic therapy (HR 0.87, 95% CI 0.83-0.92) were associated with a lower risk of 30-day in hospital mortality.
In the present study, IHCA was survived in ~ 50% in a tertiary care hospital, although only a minority of patients presented with shockable rhythms. The majority of IHCA survivors (~ 70%) had a good neurological outcome. Recovery of spontaneous circulation and presence of treatable acute causes of the arrest are associated with better survival. Clinical Characteristics, Causes and Predictors of Outcomes in Patients with In-Hospital Cardiac Arrest: Results from the SURVIVE-ARREST Study.
CPR, cardiopulmonary resuscitation; IHCA, In-hospital cardiac arrest; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; SBP, systolic blood pressure.
院内心搏骤停（IHCA）是一种急性危及生命的疾病，其死亡率和发病率仍然很高。确定 IHCA 后的死亡率预测因素有助于指导急性治疗。
我们确定了在 2014 年 1 月至 2017 年 4 月期间在一家大型三级保健医院经历 IHCA 的患者的特征和 30 天院内死亡率、神经功能结局和出院/转介途径的独立预测因素。多变量 Cox 回归模型用于评估结局预测因素。
共分析了 368 例 IHCA 患者（中位年龄 73 岁（四分位间距 65-78），123 例（33.4%）为女性）。大多数患者（45.9%）初始为非电击性节律，20.9%为电击性节律；23.6%的患者出现复发性心搏骤停。368 例患者中有 172 例（46.7%）在 30 天内死亡。在 368 例存活出院的患者中，196 例（72.9%，n=143）神经功能良好（改良 Rankin 量表≤3 分）。多变量分析显示，无机械循环支持的自主循环恢复（风险比（HR）0.36，95%置信区间（CI）0.21-0.64）、冠状动脉造影和/或经皮介入治疗（HR 0.56，95%CI 0.34-0.92）和抗生素治疗（HR 0.87，95%CI 0.83-0.92）与 30 天院内死亡率降低相关。
在本研究中，在一家三级保健医院，IHCA 的存活率约为 50%，尽管只有少数患者出现电击性节律。大多数 IHCA 幸存者（~70%）神经功能良好。自主循环的恢复和可治疗的心跳骤停的急性原因与更好的生存相关。院内心搏骤停患者的临床特征、病因和预后预测因素：SURVIVE-ARREST 研究结果。
CPR，心肺复苏术；IHCA，院内心搏骤停；MCS，机械循环支持；PCI，经皮冠状动脉介入治疗；ROSC，自主循环恢复；SBP，收缩压。
