Holmberg Mathias J, Granfeldt Asger, Moskowitz Ari, Lauridsen Kasper G, Bergum Daniel, Christiansen Christian F, Nolan Jerry P, Andersen Lars W
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
JAMA Intern Med. 2025 Apr 1;185(4):391-397. doi: 10.1001/jamainternmed.2024.7814.
There are no validated decision rules for terminating resuscitation during in-hospital cardiac arrest. Decision rules may guide termination and prevent inappropriate early termination of resuscitation.
To develop and validate termination of resuscitation rules for in-hospital cardiac arrest.
DESIGN, SETTING, AND PARTICIPANTS: In this prognostic study, potential decision rules were developed using a national in-hospital cardiac arrest registry from Denmark (data from 2017 to 2022) and validated using registries from Sweden (data from 2007 to 2021) and Norway (data from 2021 to 2022). Six variables (age, initial rhythm, witnessed status, monitored status, intensive care unit location, and resuscitation duration) were considered based on their bedside availability. Prognostic metrics were computed for all possible variable combinations. CIs were obtained using bootstrapping. Rules with a false-positive rate below 1% (predicting death in patients who might otherwise survive) and a positive rate of more than 10% (proportion of all cases for whom termination is proposed) were considered appropriate.
The primary outcome was 30-day mortality.
The cohorts included 9863 Danish, 12 781 Swedish, and 1308 Norwegian patients. The overall median (IQR) age was 74 (66-81) years, 63% were male, and the median (IQR) resuscitation duration was 13 (5-23) minutes. Of 53 864 possible termination rules, 5 were identified as relevant for clinical use. The best performing rule included 4 variables (unwitnessed, unmonitored, initial rhythm of asystole, and resuscitation duration more than or equal to 10 minutes). The rule proposed termination in 110 per 1000 cardiac arrests (positive rate, 11%; 95% CI, 10%-11%) and predicted 30-day mortality incorrectly in 6 per 1000 cases (false-positive rate, 0.6%; 95% CI, 0.3%-0.9%). All 5 rules performed similarly across all 3 cohorts.
In this prognostic study, 5 termination of resuscitation rules were developed and validated for in-hospital cardiac arrest. The best performing rule had a low false-positive rate and a reasonable positive rate in all national cohorts. These termination of resuscitation rules may aid decision-making during resuscitation.
对于院内心脏骤停期间终止复苏，尚无经过验证的决策规则。决策规则可指导终止复苏，并防止不适当的过早终止复苏。
制定并验证院内心脏骤停复苏终止规则。
设计、设置和参与者：在这项预后研究中，利用丹麦的全国院内心脏骤停登记处（2017年至2022年的数据）制定潜在的决策规则，并利用瑞典（2007年至2021年的数据）和挪威（2021年至2022年的数据）的登记处进行验证。根据六个变量（年龄、初始心律、是否有目击者、监测状态、重症监护病房位置和复苏持续时间）在床边的可获取性进行考量。计算所有可能变量组合的预后指标。通过自抽样法获得置信区间。假阳性率低于1%（预测原本可能存活的患者死亡）且阳性率超过10%（建议终止复苏的所有病例的比例）的规则被认为是合适的。
主要结局是30天死亡率。
队列包括9863名丹麦患者、12781名瑞典患者和1308名挪威患者。总体年龄中位数（四分位间距）为74（66 - 81）岁，63%为男性，复苏持续时间中位数（四分位间距）为13（5 - 23）分钟。在53864条可能的终止规则中，有5条被确定与临床应用相关。表现最佳的规则包括4个变量（无目击者、未监测、初始心律为心搏停止以及复苏持续时间大于或等于10分钟）。该规则建议在每1000次心脏骤停中有110次终止复苏（阳性率，11%；95%置信区间，10% - 11%），并且在每1000例病例中有6例错误预测30天死亡率（假阳性率，0.6%；95%置信区间，0.3% - 0.9%）。所有5条规则在所有3个队列中的表现相似。
在这项预后研究中，为院内心脏骤停制定并验证了5条复苏终止规则。表现最佳的规则在所有国家队列中具有较低的假阳性率和合理的阳性率。这些复苏终止规则可能有助于复苏期间的决策制定。
