BMJ:院内心脏骤停成人的心肺复苏持续时间和预后:回顾性队列研究

24天前 来源:BMJ

本文由小咖机器人翻译整理

期刊来源:BMJ

原文链接:https://doi.org/10.1136/bmj-2023-076019

摘要内容如下:

客观

将院内心脏骤停患者预后的时间依赖性概率量化为心肺复苏持续时间(定义为开始胸外按压与自主循环首次恢复或复苏终止之间的间隔)的函数。

设计

回顾性队列研究。

设置

美国多中心前瞻性院内心脏骤停登记。

参与者

从2000年到2021年,348996名成年患者(年龄≥18岁)接受了心肺复苏,并伴有院内心脏骤停。

主要结果指标

存活至出院和出院时良好的功能结果,定义为大脑功能类别评分为1(大脑功能良好)或2(中度大脑功能障碍)。假设所有关于终止复苏的决定都是准确的(即,如果心肺复苏持续更长时间,所有终止复苏的患者都将无法存活),如果等待自主循环首次恢复的患者在每分钟接受超过时间点的进一步心肺复苏,则估计随后存活至出院或具有良好功能结果的时间依赖性概率。

结果

在纳入的348996例患者中,233551例(66.9%)患者自主循环恢复,开始胸外按压至首次自主循环恢复的中位时间间隔为7(四分位间距3~13)min;115445例(33.1%)患者自主循环未恢复,开始胸外按压至复苏终止的中位时间间隔为20(14~30)min。78799例(22.6%)患者存活出院。在等待心肺复苏1分钟恢复自主循环的患者中,存活和良好功能预后的时间依赖概率分别为22.0%(75645/343866)和15.1%(49769/328771)。概率随着时间的推移而降低,在39分钟时存活的概率<1%,在32分钟的心肺复苏持续时间时良好功能结果的概率<1%。

结论

这项对院内心脏骤停的大型多中心注册研究的分析,量化了患者在每分钟心肺复苏持续时间内的结果的时间依赖性概率。研究结果为复苏团队、患者及其代理人提供了深入的见解,即如果等待自主循环首次恢复的患者继续接受进一步的心肺复苏,则可能获得良好的结果。

英文原文如下:

Abstracts

OBJECTIVE  To quantify time dependent probabilities of outcomes in patients after in-hospital cardiac arrest as a function of duration of cardiopulmonary resuscitation, defined as the interval between start of chest compression and the first return of spontaneous circulation or termination of resuscitation.

DESIGN  Retrospective cohort study.

SETTING  Multicenter prospective in-hospital cardiac arrest registry in the United States.

PARTICIPANTS  348 996 adult patients (≥18 years) with an index in-hospital cardiac arrest who received cardiopulmonary resuscitation from 2000 through 2021.

MAIN OUTCOME MEASURES  Survival to hospital discharge and favorable functional outcome at hospital discharge, defined as a cerebral performance category score of 1 (good cerebral performance) or 2 (moderate cerebral disability). Time dependent probabilities of subsequently surviving to hospital discharge or having favorable functional outcome if patients pending the first return of spontaneous circulation at each minute received further cardiopulmonary resuscitation beyond the time point were estimated, assuming that all decisions on termination of resuscitation were accurate (that is, all patients with termination of resuscitation would have invariably failed to survive if cardiopulmonary resuscitation had continued for a longer period of time).

RESULTS  Among 348 996 included patients, 233 551 (66.9%) achieved return of spontaneous circulation with a median interval of 7 (interquartile range 3-13) minutes between start of chest compressions and first return of spontaneous circulation, whereas 115 445 (33.1%) patients did not achieve return of spontaneous circulation with a median interval of 20 (14-30) minutes between start of chest compressions and termination of resuscitation. 78 799 (22.6%) patients survived to hospital discharge. The time dependent probabilities of survival and favorable functional outcome among patients pending return of spontaneous circulation at one minute's duration of cardiopulmonary resuscitation were 22.0% (75 645/343 866) and 15.1% (49 769/328 771), respectively. The probabilities decreased over time and were <1% for survival at 39 minutes and <1% for favorable functional outcome at 32 minutes' duration of cardiopulmonary resuscitation.

CONCLUSIONS  This analysis of a large multicenter registry of in-hospital cardiac arrest quantified the time dependent probabilities of patients' outcomes in each minute of duration of cardiopulmonary resuscitation. The findings provide resuscitation teams, patients, and their surrogates with insights into the likelihood of favorable outcomes if patients pending the first return of spontaneous circulation continue to receive further cardiopulmonary resuscitation.

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