Tresch D D, Neahring J M, Duthie E H, Mark D H, Kartes S K, Aufderheide T P
Department of Cardiology, Medical College of Wisconsin, Milwaukee 53226.
Am J Med. 1993 Aug;95(2):123-30. doi: 10.1016/0002-9343(93)90252-k.
To determine the benefits of cardiopulmonary resuscitation (CPR) in nursing home patients and assess possible prearrest and arrest predictors of survival.
During a 4-year period (1986 to 1989), consecutive nursing home patients from Milwaukee, Wisconsin, who sustained cardiac arrest and received CPR by paramedics were studied. The patients' prearrest clinical characteristics were determined including age, length of stay in nursing home, medical diagnoses, medications, circumstances surrounding the arrest, laboratory studies, and baseline functional status. Cardiac arrest data were obtained from a paramedic computer data base and included whether the arrest was witnessed, initial cardiac rhythm, and success of CPR. Survival was defined as the discharge of the patient alive from the hospital, and the patient's pre- and post-arrest functional status was compared. Possible predictors of survival were analyzed from the patient's prearrest characteristics and arrest characteristics.
Of the total 196 patients who received CPR, 37 (19%) were successfully resuscitated and hospitalized, and 10 (5%) survived to be discharged. However, 27% of patients survived whose arrests were witnessed and who demonstrated ventricular fibrillation at the time of the arrest. In comparison, only 2.3% of all other nursing home patients who received CPR survived (p < 0.0002). Age, mental or functional status, hematocrit, renal dysfunction, pulmonary disease, cancer, and cardiovascular disease were not significant predictors of survival. At the time of hospital discharge, the functional status of the majority (80%) of the survivors was comparable to their prearrest status and 40% of the survivors lived for greater than 12 months.
We conclude that only a small percentage of nursing home patients who sustain cardiac arrest will benefit from CPR. However, greater than 25% of nursing home patients whose arrest is witnessed and who demonstrate ventricular fibrillation will survive. This is comparable to the survival rate of elderly community-dwelling persons who sustain cardiac arrest. Our data suggest that CPR should be initiated only in nursing home patients whose cardiac arrest is witnessed and should only be continued in patients whose initial documented cardiac rhythm is ventricular fibrillation or ventricular tachycardia.
确定心肺复苏术（CPR）对疗养院患者的益处，并评估可能的心脏骤停前及骤停时的生存预测因素。
在1986年至1989年的4年期间，对来自威斯康星州密尔沃基市的连续发生心脏骤停并接受护理人员心肺复苏术的疗养院患者进行了研究。确定了患者心脏骤停前的临床特征，包括年龄、在疗养院的住院时间、医学诊断、用药情况、心脏骤停时的周围环境、实验室检查以及基线功能状态。心脏骤停数据来自护理人员的计算机数据库，包括心脏骤停是否被目击、初始心律以及心肺复苏术的成功情况。生存定义为患者从医院活着出院，并比较了患者心脏骤停前后的功能状态。从患者心脏骤停前的特征和骤停特征分析可能的生存预测因素。
在总共接受心肺复苏术的196例患者中，37例（19%）成功复苏并住院，10例（5%）存活至出院。然而，心脏骤停被目击且在骤停时表现为心室颤动的患者中有27%存活。相比之下，接受心肺复苏术的所有其他疗养院患者中只有2.3%存活（p<0.0002）。年龄、精神或功能状态、血细胞比容、肾功能不全、肺部疾病、癌症和心血管疾病不是生存的显著预测因素。出院时，大多数（80%）幸存者的功能状态与心脏骤停前相当，40%的幸存者存活超过12个月。
我们得出结论，只有一小部分发生心脏骤停的疗养院患者能从心肺复苏术中获益。然而，心脏骤停被目击且表现为心室颤动的疗养院患者中超过25%将存活。这与社区老年心脏骤停患者的存活率相当。我们的数据表明，仅应对心脏骤停被目击的疗养院患者实施心肺复苏术，且仅应对初始记录的心律为心室颤动或室性心动过速的患者继续进行心肺复苏术。
