Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia.
Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Intensive Care Med. 2024 Sep;50(9):1496-1505. doi: 10.1007/s00134-024-07570-w. Epub 2024 Aug 8.
Perioperative in-hospital cardiac arrests (Perioperative IHCAs) may have better outcomes than IHCAs in the ward (Ward IHCAs), due to enhanced monitoring and faster response. However, quantitative comparisons of their long-term outcomes are lacking, posing challenges for prognostication.
This retrospective multicentre study included adult intensive care unit (ICU) admissions from theatre/recovery or wards with a diagnosis of cardiac arrest between January 2018 and March 2022. We used data from 175 ICUs in the ANZICS adult patient database. The primary outcome was a survival time of up to 4 years. We used the Cox proportional hazards model adjusted for Sequential Organ Failure Assessment (SOFA) score, age, sex, comorbidities, hospital type, treatment limitation on admission to the ICU, and ICU treatments. Subgroup analyses examined age (≥ 65 years), intubation within the first 24 h, elective vs. emergency admission, and survival on discharge.
Of 702,675 ICU admissions, 5,659 IHCAs were included (Perioperative IHCA 38%; Ward IHCA 62%). Perioperative IHCA group were younger, less frail, and less comorbid. Perioperative IHCA were most frequent in patients admitted to ICU after cardiovascular, gastrointestinal, or trauma surgeries. Perioperative IHCA group had longer 4-year survival (59.9% vs. 33.0%, p < 0.001) than the Ward IHCA group, even after adjustments (adjusted hazard ratio [HR]: 0.63, 95% confidence interval [CI] 0.57-0.69). This was concordant across all subgroups. Of note, older patients with Perioperative IHCA survived longer than both younger and older patients with Ward IHCA.
Patients admitted to the ICU following Perioperative IHCA had longer survival than Ward IHCA. Future studies on IHCA should distinguish these patients.
由于加强了监测和更快的反应，围手术期院内心搏骤停（围手术期 IHCA）的预后可能优于病房内心搏骤停（病房 IHCA）。然而，缺乏对其长期预后的定量比较，这对预后评估构成了挑战。
本回顾性多中心研究纳入了 2018 年 1 月至 2022 年 3 月期间来自手术/复苏室或病房的患有心搏骤停诊断的成年重症监护病房（ICU）患者。我们使用了来自 ANZICS 成年患者数据库的 175 个 ICU 的数据。主要结局是 4 年的生存时间。我们使用了调整了序贯器官衰竭评估（SOFA）评分、年龄、性别、合并症、医院类型、入住 ICU 时的治疗限制以及 ICU 治疗的 Cox 比例风险模型。亚组分析检查了年龄（≥65 岁）、24 小时内插管、择期与紧急入院以及出院时的存活情况。
在 702675 例 ICU 入院患者中，纳入了 5659 例心搏骤停患者（围手术期 IHCA 占 38%；病房 IHCA 占 62%）。围手术期 IHCA 组年龄较小，身体较弱，合并症较少。围手术期 IHCA 最常见于接受心血管、胃肠道或创伤手术后转入 ICU 的患者。即使经过调整，围手术期 IHCA 组的 4 年生存率也更长（59.9%比 33.0%，p<0.001）（调整后的危险比[HR]：0.63，95%置信区间[CI]：0.57-0.69）。这在所有亚组中都是一致的。值得注意的是，围手术期 IHCA 中的老年患者比病房 IHCA 中的年轻和老年患者存活时间都更长。
接受围手术期 IHCA 治疗后转入 ICU 的患者的生存率高于接受病房 IHCA 治疗的患者。未来的心搏骤停研究应区分这些患者。
