Department of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2024 Nov;68(10):1504-1514. doi: 10.1111/aas.14496. Epub 2024 Jul 11.
Non-shockable in-hospital cardiac arrest (IHCA) is a condition with diverse aetiology, predictive factors, and outcome. This study aimed to compare IHCA with initial asystole or pulseless electrical activity (PEA), focusing specifically on their aetiologies and the significance of predictive factors.
Using the Swedish Registry of Cardiopulmonary Resuscitation, adult non-shockable IHCA cases from 2018 to 2022 (n = 5788) were analysed. Exposure was initial rhythm, while survival to hospital discharge was the primary outcome. A random forest model with 28 variables was used to generate permutation-based variable importance for outcome prediction.
Overall, 60% of patients (n = 3486) were male and the median age was 75 years (IQR 67-81). The most frequent arrest location (46%) was on general wards. Comorbidities were present in 79% of cases and the most prevalent comorbidity was heart failure (33%). Initial rhythm was PEA in 47% (n = 2702) of patients, and asystole in 53% (n = 3086). The most frequent aetiologies in both PEA and asystole were cardiac ischemia (24% vs. 19%, absolute difference [AD]: 5.4%; 95% confidence interval [CI] 3.0% to 7.7%), and respiratory failure (14% vs. 13%, no significant difference). Survival was higher in asystole (24%) than in PEA (17%) (AD: 7.3%; 95% CI 5.2% to 9.4%). Cardiopulmonary resuscitation (CPR) durations were longer in PEA, 18 vs 15 min (AD 4.9 min, 95% CI 4.0-5.9 min). The duration of CPR was the single most important predictor of survival across all subgroup and sensitivity analyses. Aetiology ranked as the second most important predictor in most analyses, except in the asystole subgroup where responsiveness at cardiac arrest team arrival took precedence.
In this nationwide registry study of non-shockable IHCA comparing asystole to PEA, cardiac ischemia and respiratory failure were the predominant aetiologies. Duration of CPR was the most important predictor of survival, followed by aetiology. Asystole was associated with higher survival compared to PEA, possibly due to shorter CPR durations and a larger proportion of reversible aetiologies.
院内非心搏骤停性心脏骤停（IHCA）是一种病因、预测因素和预后各不相同的病症。本研究旨在比较初始为心搏停止或无脉性电活动（PEA）的 IHCA，重点关注它们的病因和预测因素的重要性。
利用瑞典心肺复苏注册中心的数据，对 2018 年至 2022 年期间的成年非心搏骤停性 IHCA 病例（n=5788）进行了分析。暴露因素为初始节律，主要结局为存活至出院。使用具有 28 个变量的随机森林模型对预后预测的排列变量重要性进行了分析。
总体而言，60%的患者（n=3486）为男性，中位年龄为 75 岁（IQR 67-81）。最常见的停搏部位（46%）是普通病房。79%的病例存在合并症，最常见的合并症是心力衰竭（33%）。初始节律为 PEA 的患者占 47%（n=2702），为心搏停止的占 53%（n=3086）。PEA 和心搏停止的最常见病因均为心脏缺血（24%比 19%，绝对差异[AD]：5.4%；95%置信区间[CI] 3.0%至 7.7%）和呼吸衰竭（14%比 13%，无显著差异）。心搏停止的存活率（24%）高于 PEA（17%）（AD：7.3%；95%CI 5.2%至 9.4%）。PEA 的心肺复苏（CPR）持续时间为 18 分钟，而 PEA 为 15 分钟（AD 4.9 分钟，95%CI 4.0 至 5.9 分钟）。CPR 持续时间是所有亚组和敏感性分析中存活的最重要预测因素。在大多数分析中，病因均被列为第二重要的预测因素，除了心搏停止亚组中，到达心脏骤停救治团队时的反应性更为重要。
在这项比较心搏停止和 PEA 的非心搏骤停性 IHCA 的全国性登记研究中，心脏缺血和呼吸衰竭是最主要的病因。CPR 持续时间是存活的最重要预测因素，其次是病因。与 PEA 相比，心搏停止与更高的存活率相关，可能是由于 CPR 持续时间更短，以及更可能存在可逆转的病因。
