Albert Malin, Herlitz Johan, Rawshani Araz, Forsberg Sune, Ringh Mattias, Hollenberg Jacob, Claesson Andreas, Thuccani Meena, Lundgren Peter, Jonsson Martin, Nordberg Per
Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
Eur Heart J Open. 2023 Jun 22;3(4):oead066. doi: 10.1093/ehjopen/oead066. eCollection 2023 Jul.
To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.
Observational study with data from national registries. Specific aetiologies ( = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes ( < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).
In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.
研究院内心脏骤停（IHCA）的病因及其与30天生存率的关联。
基于国家登记处数据的观察性研究。将2018年4月至2020年12月期间IHCA患者的特定病因（n = 22）分为心脏性与非心脏性病因，以及六个主要病因类别：心肌缺血、其他心脏病因、肺部病因、感染、出血和其他非心脏病因。主要终点为各病因的比例、30天生存率以及出院时良好的神经功能结局（脑功能分类量表1 - 2级）。在纳入的4320例IHCA患者中（中位年龄74岁，63.1%为男性），约50%为心脏病因，其30天生存率为48.4%，而非心脏病因患者的30天生存率为18.7%（P < 0.001）。各病因类别所占比例分别为：心肌缺血29.9%、肺部21.4%、其他心脏病因19.6%、其他非心脏病因11.6%、感染9%、出血8.5%。与心肌缺血相比，各病因类别30天生存的比值比（OR）分别为：其他心脏病因OR 1.48（95%置信区间[CI] 1.24 - 1.76）；肺部病因OR 0.36（CI 0.3 - 0.44）；感染OR 0.25（CI 0.18 - 0.33）；出血OR 0.22（CI 0.16 - 0.3）；其他非心脏病因OR 0.56（CI 0.45 - 0.69）。由心肌缺血导致的IHCA具有最佳的良好神经功能结局，而由感染导致的IHCA的比值比最低，为0.06（CI 0.03 - 0.13）。
在这项全国性观察性研究中，IHCA的心脏性和非心脏性病因分布均匀。由心肌缺血和其他心脏病因导致的IHCA与30天生存率及神经功能结局的关联最为密切。
