Fried T R, Miller M A, Stein M D, Wachtel T J
Rhode Island Hospital, Brown University, Providence, USA.
J Gen Intern Med. 1996 May;11(5):257-61. doi: 10.1007/BF02598264.
To determine the extent of variability in the administration of advanced cardiac life support (ACLS) and to determine if age is associated with variability.
Retrospective cohort.
Urban teaching hospital.
One hundred twenty-two adult inpatients without a "do-not resuscitate" order who suffered cardiopulmonary arrest during 1993.
Of the total, 35 (29%) survived the arrest and 87 (71%) died. Among the nonsurvivors, two patients received no ACLS and six were not intubated, despite the inclusion of intubation in all ACLS protocols. Of the 87 nonsurvivors, 31 had a single electrocardiographic rhythm during their arrest and should have had similar ACLS trials. However, the 9 nonsurvivors with ventricular fibrillation received a range of 0 to 17 interventions, the 11 with electromechanical dissociation received 1 to 22, and the 11 with asystole received 0 to 14. Based on a protocol-derived definition of a minimal trial of ACLS (a "short ACLS trial") for all 87 nonsurvivors, age greater than 75 was associated with receiving a short trial. Dependent functional status and being on a medical service were also associated with a short ACLS trial. In a logistic regression model including these variables as covariates, age remained significantly associated with a short ACLS trial; odds ratio, 9.71 (95% confidence interval 1.68, 56.1).
Wide variability exists in the administration of ACLS at the studied site. The finding that some patients receive no ACLS suggests that physicians at this site may be making bedside determinations of the likelihood of its benefit based on individual patient characteristics. The association between older age and short ACLS trials among all nonsurvivors suggests that age is most important of these characteristics.
确定高级心脏生命支持（ACLS）实施过程中的变异性程度，并确定年龄是否与变异性相关。
回顾性队列研究。
城市教学医院。
1993年期间发生心肺骤停且无“不要复苏”医嘱的122名成年住院患者。
总计35例（29%）患者骤停后存活，87例（71%）死亡。在未存活患者中，2例未接受任何ACLS，6例未进行气管插管，尽管所有ACLS方案均包含气管插管。在87例未存活患者中，31例在骤停期间有单一心电图节律，本应接受相似的ACLS尝试。然而，9例心室颤动的未存活患者接受的干预次数从0次到17次不等，11例电机械分离患者接受1次到22次，11例心脏停搏患者接受0次到14次。根据针对所有87例未存活患者的基于方案的ACLS最小尝试定义（“简短ACLS尝试”），年龄大于75岁与接受简短尝试相关。依赖的功能状态以及接受医疗服务也与简短ACLS尝试相关。在一个将这些变量作为协变量的逻辑回归模型中，年龄仍与简短ACLS尝试显著相关；比值比为9.71（95%置信区间1.68, 56.1）。
在所研究的地点，ACLS的实施存在很大变异性。一些患者未接受ACLS这一发现表明，该地点的医生可能根据个体患者特征在床边判断其获益的可能性。在所有未存活患者中，年龄较大与简短ACLS尝试之间的关联表明，年龄是这些特征中最重要的。
