Zabel Kenneth M, Quazi Mohammed A, Leyba Katarina, Millhuff Alexandra C, Madi Mikel, Madrid Wilfredo Henriquez, Goyal Aman, Bilal Muhammad Ibraiz, Sohail Amir H, Sagheer Shazib, Sheikh Abu Baker
Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Department of Biostatistics and Mathematics, University of New Mexico, Albuquerque, NM 87113, USA.
J Clin Med. 2024 Sep 20;13(18):5585. doi: 10.3390/jcm13185585.
: Despite resuscitative efforts, cardiac arrest (CA) continues to result in high mortality and poor prognosis. However, a gap remains in understanding the comparative outcomes of efforts in emergency departments (ED) over recent years. This study evaluated patients with CA during ED visits, with a particular focus on outcomes of mortality and transition of care. : We conducted a retrospective cohort analysis using the National Emergency Department Sample (NEDS) database. The study population included patients aged 18 years or older who visited the ED between January 2016 and December 2020. Statistical analysis of patients and hospital characteristics included chi-squared tests for independence and multivariable logistic regression models to report the associations of factors with mortality in the ED and disposition from the ED. The primary outcome measured was mortality in the ED, and the secondary outcome included transition of care. : A total of 699,822,424 ED visits occurred between 2016 and 2020, with 1,414,060 (0.20%) CAs. The survival rate from CA ranged from 24.6% to 28.1%. In 2020, the rate of ED CA increased to 0.27%, with an inpatient mortality rate of 58.8%. There was no significant difference in mortality between sexes ( = 0.690). There was a trend for higher mortality in the ED among patients who were self-paid. Notably, the odds of transfer from the ED to other hospitals were significantly lower in minority groups. : Our results showed significant disparities in ED mortality and patient disposition following cardiac arrest, highlighting the need for equitable healthcare resources and policies.
尽管进行了复苏努力，但心脏骤停（CA）仍然导致高死亡率和不良预后。然而，近年来在理解急诊科（ED）各项努力的比较结果方面仍存在差距。本研究评估了急诊科就诊期间发生心脏骤停的患者，特别关注死亡率和护理转接结果。
我们使用国家急诊科样本（NEDS）数据库进行了一项回顾性队列分析。研究人群包括2016年1月至2020年12月期间前往急诊科就诊的18岁及以上患者。对患者和医院特征的统计分析包括独立性卡方检验和多变量逻辑回归模型，以报告各因素与急诊科死亡率及从急诊科转出情况的关联。测量的主要结局是急诊科死亡率，次要结局包括护理转接情况。
2016年至2020年期间，急诊科共发生699,822,424次就诊，其中1,414,060次（0.20%）为心脏骤停。心脏骤停后的生存率在24.6%至28.1%之间。2020年，急诊科心脏骤停发生率升至0.27%，住院死亡率为58.8%。男女死亡率无显著差异（P = 0.690）。自费患者在急诊科的死亡率有升高趋势。值得注意的是，少数群体从急诊科转至其他医院的几率显著较低。
我们的结果显示，心脏骤停后急诊科死亡率和患者处置情况存在显著差异，凸显了公平医疗资源和政策的必要性。
