分娩期间的心脏骤停：一项队列研究。

Cardiac Arrest During Delivery Hospitalization : A Cohort Study.

机构信息

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (N.D.F., C.L.D., R.R.G.).

Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (E.V.K., L.S.S.).

出版信息

Ann Intern Med. 2023 Apr;176(4):472-479. doi: 10.7326/M22-2750. Epub 2023 Mar 14.

DOI:10.7326/M22-2750

PMID:36913690

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10264156/

Abstract

BACKGROUND

Estimates of cardiac arrest occurring during delivery guide evidence-based strategies to reduce pregnancy-related death.

OBJECTIVE

To investigate rate of, maternal characteristics associated with, and survival after cardiac arrest during delivery hospitalization.

DESIGN

Retrospective cohort study.

SETTING

U.S. acute care hospitals, 2017 to 2019.

PARTICIPANTS

Delivery hospitalizations among women aged 12 to 55 years included in the National Inpatient Sample database.

MEASUREMENTS

Delivery hospitalizations, cardiac arrest, underlying medical conditions, obstetric outcomes, and severe maternal complications were identified using codes from the International Classification of Diseases, 10th Revision, Clinical Modification. Survival to hospital discharge was based on discharge disposition.

RESULTS

Among 10 921 784 U.S. delivery hospitalizations, the cardiac arrest rate was 13.4 per 100 000. Of the 1465 patients who had cardiac arrest, 68.6% (95% CI, 63.2% to 74.0%) survived to hospital discharge. Cardiac arrest was more common among patients who were older, were non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. Acute respiratory distress syndrome was the most common co-occurring diagnosis (56.0% [CI, 50.2% to 61.7%]). Among co-occurring procedures or interventions examined, mechanical ventilation was the most common (53.2% [CI, 47.5% to 59.0%]). The rate of survival to hospital discharge after cardiac arrest was lower with co-occurring disseminated intravascular coagulation (DIC) without or with transfusion (50.0% [CI, 35.8% to 64.2%] or 54.3% [CI, 39.2% to 69.5%], respectively).

LIMITATIONS

Cardiac arrests occurring outside delivery hospitalizations were not included. The temporality of arrest relative to the delivery or other maternal complications is unknown. Data do not distinguish cause of cardiac arrest, such as pregnancy-related complications or other underlying causes among pregnant women.

CONCLUSION

Cardiac arrest was observed in approximately 1 in 9000 delivery hospitalizations, among which nearly 7 in 10 women survived to hospital discharge. Survival was lowest during hospitalizations with co-occurring DIC.

PRIMARY FUNDING SOURCE

None.

摘要

背景

心脏骤停发生率的评估有助于制定基于证据的策略，以降低与妊娠相关的死亡率。

目的

调查分娩期间心脏骤停的发生率、与产妇相关的特征以及存活情况。

设计

回顾性队列研究。

设置

美国急性护理医院，2017 年至 2019 年。

参与者

纳入国家住院患者样本数据库的年龄在 12 至 55 岁之间的分娩住院患者。

测量方法

使用国际疾病分类第 10 版临床修订版中的代码识别分娩住院、心脏骤停、基础医疗状况、产科结局和严重产妇并发症。基于出院处置确定存活至出院。

结果

在 10921784 例美国分娩住院中，心脏骤停发生率为每 100000 例 13.4 例。在 1465 例发生心脏骤停的患者中，68.6%（95%CI，63.2%至 74.0%）存活至出院。心脏骤停更常见于年龄较大、非西班牙裔黑人、有医疗保险或医疗补助、或有基础医疗状况的患者。急性呼吸窘迫综合征是最常见的合并诊断（56.0%[CI，50.2%至 61.7%]）。在所检查的合并手术或干预中，机械通气最常见（53.2%[CI，47.5%至 59.0%]）。合并弥散性血管内凝血（DIC）但未输血（50.0%[CI，35.8%至 64.2%]）或合并 DIC 并输血（54.3%[CI，39.2%至 69.5%]）的患者出院存活率较低。