成熟医疗应急团队的澳大利亚医院院内心搏骤停的发生前情况和结果：一项多中心前瞻性观察研究。
Antecedents to and outcomes for in-hospital cardiac arrests in Australian hospitals with mature medical emergency teams: A multicentre prospective observational study.
机构信息
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
出版信息
Aust Crit Care. 2023 Nov;36(6):1059-1066. doi: 10.1016/j.aucc.2023.01.011. Epub 2023 Apr 12.
BACKGROUND
The epidemiology and predictability of in-hospital cardiac arrests (IHCAs) in hospitals with established medical emergency teams (METs) is underinvestigated.
OBJECTIVES
We categorised IHCAs into three categories: "possible suboptimal end-of-life planning" (possible SELP), "potentially predictable", or "sudden and unexpected" using age, Charlson Comorbidity Index, place of residence, functional independence, along with documented vital signs, K and HCO in the period prior to the IHCA. We also described the differences in characteristics and outcomes amongst these three categories of IHCAs.
METHODS
This was a prospective observational study (1st July 2017 to 9th August 2018) of adult (18 years) IHCA patients in wards of seven Australian hospitals with well-established METs.
RESULTS
Amongst 152 IHCA patients, 145 had complete data. The number (%) classified as possible SELP, potentially predictable, and sudden and unexpected IHCA was 50 (34.5%), 52 (35.8%), and 43 (29.7%), respectively. Amongst the 52 potentially predictable patients, six (11.5%) had missing vital signs in the preceding 6 hr, 18 (34.6%) breached MET criteria in the prior 24 hr but received no MET call, and 6 (11.5%) had a MET call but remained on the ward. Abnormal K and HCO was present in 15 of 51 (29.5%) and 13 of 51 (25.5%) of such patients, respectively. The 43 sudden and unexpected IHCA patients were mostly (97.6%) functionally independent and had the lowest median Charlson Comorbidity Index. In-hospital mortality for IHCAs classified as possible SELP, potentially predictable, and sudden and unexpected was 76.0%, 61.5%, and 44.2%, respectively (p = 0.007). Only four of 12 (33.3%) possible SELP survivors had a good functional outcome.
CONCLUSIONS
In seven Australian hospitals with mature METs, only one-third of IHCAs were sudden and unexpected. Improving end-of-life care in elderly comorbid patients and enhancing the response to objective signs of deterioration may further reduce IHCAs in the Australian context.
背景
在已经建立了医疗应急团队（MET）的医院中，院内心搏骤停（IHCA）的流行病学和可预测性研究不足。
目的
我们使用年龄、Charlson 合并症指数、居住地点、功能独立性以及 IHCA 发生前记录的生命体征、K 和 HCO 值，将 IHCA 分为三类：“可能的临终规划不佳”（可能的 SELP）、“可能可预测”或“突然和意外”。我们还描述了这三类 IHCA 在特征和结局方面的差异。
方法
这是一项前瞻性观察研究（2017 年 7 月 1 日至 2018 年 8 月 9 日），纳入了澳大利亚七家医院病房中年龄在 18 岁及以上的成人 IHCA 患者。
结果
在 152 例 IHCA 患者中，有 145 例患者资料完整。分类为可能的 SELP、可能可预测和突然和意外 IHCA 的患者分别为 50 例（34.5%）、52 例（35.8%）和 43 例（29.7%）。在 52 例可能可预测的患者中，有 6 例（11.5%）在之前的 6 小时内生命体征缺失，18 例（34.6%）在之前的 24 小时内违反了 MET 标准但未接到 MET 电话，6 例（11.5%）接到了 MET 电话但仍在病房内。在 51 例患者中，有 15 例（29.5%）和 13 例（25.5%）的 K 和 HCO 值异常。43 例突然和意外 IHCA 患者大多数（97.6%）功能独立，Charlson 合并症指数最低。分类为可能的 SELP、可能可预测和突然和意外的 IHCA 患者的院内死亡率分别为 76.0%、61.5%和 44.2%（p=0.007）。在 12 例可能的 SELP 幸存者中，仅有 4 例（33.3%）功能良好。
结论
在澳大利亚的七家成熟 MET 医院中，只有三分之一的 IHCA 是突然和意外的。改善老年合并症患者的临终关怀和增强对客观恶化迹象的反应可能会进一步降低澳大利亚的 IHCA 发生率。
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