疑似心血管病因的院内心脏骤停复苏的挑战与生存因素：中国北京的一项多中心回顾性研究

Challenges in resuscitation and survival factors of in-hospital cardiac arrest with suspected cardiovascular etiology: A multicenter retrospective study in Beijing, China.

作者信息

Zhang Ya, Ding Yao, Yu Yang, Ma Yuan, Xiao Ziyue, Su Jianting, Wang Jing, Liu Xiaojie, Wang Jingcan, Wei Zaihua, Ao Hushan

机构信息

Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China.

The First Clinical Medical College, Lanzhou University, No.1, Donggangxi Road, Chengguan District, Lanzhou, Gansu Province, China.

出版信息

Resusc Plus. 2025 Aug 5;25:101053. doi: 10.1016/j.resplu.2025.101053. eCollection 2025 Sep.

DOI:10.1016/j.resplu.2025.101053

PMID:40896575

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12391814/

Abstract

BACKGROUND AND AIM

Cardiovascular disease affects both the elderly and younger populations, with cardiogenic arrest being the leading cause of in-hospital cardiac arrest (IHCA). The prognosis of IHCA related to cardiovascular diseases remains uncertain. This study aims to explore the characteristics, outcomes, and survival factors of IHCA with suspected cardiovascular etiology.

METHODS AND RESULTS

This retrospective study investigated IHCA suspected to be of cardiovascular origin among adult patients across multiple hospitals in Beijing, China, from January 2022 to December 2023. A total of 791 arrests were recorded, with a median age of 70 years (IQR 61-79), and 65.1 % were male. Ventricular fibrillation/pulseless ventricular tachycardia was the initial rhythm in 46.8 % of cases. Of the 791 patients, 394 (49.8 %) achieved return of spontaneous circulation (ROSC), and 302 (38.2 %) had more than one arrest during hospitalization. Ultimately, 130 patients (16.4 %) survived to hospital discharge. Multivariable Cox regression showed that ROSC without mechanical circulatory support (HR: 2.68; 95 % CI 1.58-4.56), shockable initial rhythm (HR: 1.52; 95 % CI 1.06-2.17), and a duration of cardiopulmonary resuscitation (CPR) of ≤ 30 min (HR: 1.82; 95 % CI 1.13-2.93) were independently associated with a higher likelihood of survival to discharge. In contrast, multiple CPR episodes (HR: 0.53; 95 % CI 0.36-0.76), prolonged hospital stays (HR: 0.90; 95 % CI 0.88-0.93), and IHCA in urban centers (HR: 0.60; 95 % CI 0.42-0.87) were linked to poorer survival.

CONCLUSIONS

Among patients with suspected cardiovascular-related IHCA, both the proportion of shockable initial rhythms and ROSC rates were high; however, survival to discharge remained low.

摘要

背景与目的

心血管疾病影响老年和年轻人群，心源性骤停是院内心脏骤停（IHCA）的主要原因。与心血管疾病相关的IHCA的预后仍不确定。本研究旨在探讨疑似心血管病因的IHCA的特征、结局和生存因素。

方法与结果

这项回顾性研究调查了2022年1月至2023年12月期间中国北京多家医院成年患者中疑似心血管源性的IHCA。共记录了791例心脏骤停事件，中位年龄为70岁（四分位间距61 - 79岁），男性占65.1%。46.8%的病例初始心律为心室颤动/无脉性室性心动过速。在791例患者中，394例（49.8%）实现自主循环恢复（ROSC），302例（38.2%）在住院期间发生不止一次心脏骤停。最终，130例患者（16.4%）存活至出院。多变量Cox回归显示，无机械循环支持的ROSC（风险比：2.68；95%置信区间1.58 - 4.56）、可电击复律的初始心律（风险比：1.52；95%置信区间1.06 - 2.17）以及心肺复苏（CPR）持续时间≤30分钟（风险比：1.82；95%置信区间1.13 - 2.93）与出院存活可能性较高独立相关。相反，多次CPR发作（风险比：0.53；95%置信区间0.36 - 0.76）、住院时间延长（风险比：0.90；95%置信区间0.88 - 0.93）以及城市中心的IHCA（风险比：0.60；95%置信区间0.42 - 0.87）与较差的生存情况相关。