Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Göteborgsvägen 31, Mölndal 431 30, Sweden; Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
PreHospen - Centre of Prehospital Research, Academy of Caring Science, Welfare and Work Life, University of Borås 501 90 Borås, Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Int J Cardiol. 2023 Jun 15;381:112-119. doi: 10.1016/j.ijcard.2023.03.069. Epub 2023 Apr 5.
The aim of the study was to investigate what characterizes IHCAs that take place during the "day" (Monday-Friday 7 am-3 pm), "evening" (Monday-Friday 3 pm-9 pm) and "night" (Monday-Friday 9 pm-7 am and Saturday-Sunday 12 am- 11.59 pm).
We used the Swedish Registry for CPR (SRCR) to study 26,595 patients from January 1, 2008 to December 31, 2019. Adult patients ≥18 years with a IHCA where resuscitation was initiated were included. Uni- and multivariable logistic regression was used to investigate associations between temporal factors and survival to 30 days.
30-day survival and Return of Spontaneous Circulation (ROSC) was 36.8% and 67.9% following CA during the day and decreased during the evening (32.0% and 66.3%) and night (26.2% and 60.2%) (p < 0.001 and p = 0.028). When comparing the survival rates between the day and the night, survival decreased more (change in relative survival rates) in small (<99 beds) compared to large (<400) hospitals (35.9% vs 25%), in non-academic vs academic hospitals (33.5% vs 22%) and on non-Electro Cardiogram (ECG)-monitored wards vs ECG-monitored wards (46.2% vs 20.9%) (p < 0.001 for all). IHCAs that took place during the day (adjusted Odds Ratio (aOR) 1.47 95% CI 1.35-1.60), in academic hospitals (aOR 1.14 95% CI 1.02-1.27) and in large (>400 beds) hospitals (aOR 1.31 95% CI 1.10-1.55) were independently associated with an increased chance of survival.
Patients suffering an IHCA have an increased chance of survival during the day vs the evening vs night, and the difference in survival is even more pronounced when cared for at smaller, non-academic hospitals, general wards and wards without ECG-monitoring capacity.
本研究旨在探讨发生在“白天”（周一至周五上午 7 点至下午 3 点）、“傍晚”（周一至周五下午 3 点至晚上 9 点）和“夜间”（周一至周五晚上 9 点至上午 7 点以及周六至周日午夜 12 点至晚上 11 点 59 分）的院外心脏骤停（IHCA）有何特点。
我们使用瑞典心肺复苏登记处（SRCR）研究了 2008 年 1 月 1 日至 2019 年 12 月 31 日期间的 26595 名患者。纳入年龄≥18 岁且接受复苏治疗的 IHCA 成年患者。采用单变量和多变量逻辑回归分析探讨时间因素与 30 天生存的相关性。
白天发生的 CA 后 30 天生存率和自主循环恢复（ROSC）分别为 36.8%和 67.9%，傍晚（32.0%和 66.3%）和夜间（26.2%和 60.2%）下降（p<0.001 和 p=0.028）。与白天相比，夜间的存活率下降更明显（相对存活率变化），小医院（<99 张床）与大医院（≥400 张床）相比（35.9%比 25%）、非学术医院与学术医院相比（33.5%比 22%）、非心电图监测病房与心电图监测病房相比（46.2%比 20.9%）（所有 p<0.001）。白天（调整后优势比（aOR）1.47，95%置信区间（CI）1.35-1.60）、学术医院（aOR 1.14，95%CI 1.02-1.27）和大医院（>400 张床）（aOR 1.31，95%CI 1.10-1.55）发生 IHCA 与存活率增加独立相关。
与傍晚和夜间相比，白天发生 IHCA 的患者有更高的生存机会，而在较小、非学术、普通病房和无心电图监测能力的病房接受治疗时，生存机会的差异更为显著。
