Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
Resuscitation. 2023 Jul;188:109762. doi: 10.1016/j.resuscitation.2023.109762. Epub 2023 Mar 15.
Withdrawal of life-sustaining therapies for perceived poor neurological prognosis is the most common cause of death for patients hospitalized after resuscitation from cardiac arrest. Accurate neuroprognostication is challenging and high stakes, so guidelines recommend multimodality testing. We quantified the frequency and timing with which guideline recommended diagnostics were acquired prior to in-hospital death after cardiac arrest.
We performed a retrospective cohort study using the Optum® deidentified Electronic Health Record dataset for 2010 to 2021. We included in-hospital decedents admitted after resuscitation from non-traumatic cardiac arrest. We quantified the number of decedents who underwent head computed tomographic imaging, electroencephalography, somatosensory evoked potentials, brain magnetic resonance imaging, or evaluation by a neurologist, as well as the timing of these tests.
Of 34,585 included patients, median age was 66 [interquartile range 53 - 79] years and 13,609 (39%) were female. Median hospital length of stay was 0 days [0-1] days, and only 16% of deaths occurred on or after day three. Only 3,245 patients (9%) had at least one neurodiagnostic test acquired and only 1,708 (5%) were evaluated by a neurologist. The most common neurological diagnostic test to be obtained was CT imaging, acquired in 3,004 (9%) of the overall cohort. Only 852 patients (2%) of patients had at least two diagnostic modalities obtained.
In this retrospective cohort, we found few patients hospitalized after out-of-hospital cardiac arrest underwent guideline-recommended prognostic testing. If validated in prospective cohorts with more granular clinical information, better guideline adherence and more frequent use of multimodality neuroprognostication offer an opportunity to improve quality of post-arrest care.
对于因预期神经预后不良而停止维持生命的治疗，是心脏骤停复苏后住院患者死亡的最常见原因。准确的神经预后评估具有挑战性且风险很高，因此指南建议进行多模态检测。我们量化了心脏骤停复苏后住院死亡前获得指南推荐的诊断的频率和时间。
我们使用 Optum®去识别电子健康记录数据集进行了回顾性队列研究，时间范围为 2010 年至 2021 年。我们纳入了因非创伤性心脏骤停复苏后住院的死亡患者。我们量化了接受头部计算机断层扫描成像、脑电图、体感诱发电位、脑磁共振成像或神经科医生评估的死亡人数，以及这些检查的时间。
在 34585 名纳入患者中，中位年龄为 66 岁[四分位数范围 53-79 岁]，13609 名（39%）为女性。中位住院时间为 0 天[0-1 天]，仅 16%的死亡发生在第 3 天或之后。只有 3245 名患者（9%）进行了至少一项神经诊断测试，只有 1708 名（5%）接受了神经科医生的评估。最常见的神经学诊断测试是 CT 成像，在整个队列中的 3004 名患者中进行[9%]。只有 852 名患者（2%）进行了至少两种诊断方式。
在这项回顾性队列研究中，我们发现很少有因院外心脏骤停而住院的患者进行了指南推荐的预后检测。如果在具有更详细临床信息的前瞻性队列中得到验证，更好地遵循指南和更频繁地使用多模态神经预后评估提供了改善复苏后护理质量的机会。
