基于乌斯坦因模式的心肺复苏研究报告

目的 心肺复苏Utstein评价模式已被许多国家广泛用于心肺复苏评价研究.本文以心肺复苏结果Utstein评价模式设计心肺复苏注册登记表,以评价中国海南海南省人民医院心搏骤停患者流行病学特征、心肺复苏效果与影响因素.方法 应用心肺复苏Utstein模式注册登记表,对海南省人民医院急诊科511例心肺复苏患者进行前瞻性观察研究,评价本组患者心搏骤停流行病学特征及心肺复苏结果.结果 注册登记的511例心肺复苏患者纳入研究.本研究患者以40 ～ 70岁等年龄段心搏骤停发生率较高.既往史中,心血管系统疾病(190例,37.2％)、脑血管疾病(48例,9.4％)及呼吸系统疾病(39例,7.6％)等慢性疾病较为常见.173例(33.9％)为心源性心搏骤停,其中109例(21.3％)为急性心肌梗死.80例(15.7％)患者首次监测心律为心室纤颤.院内心搏骤停患者自主循环恢复率及成活出院率分别为47.0％和13.5％,院外心搏骤停患者为16.7％和4.7％.结论 本研究表明心血管系统疾病、脑血管疾病及呼吸系统疾病为最常见慢性疾病.急性心肌梗死、中风及创伤为最常见心搏骤停病因.院内心搏骤停组自主循环恢复率及成活出院率均高于院外心搏骤停组,两组差异具有统计学意义.     

急性心肌梗死并发心搏骤停抢救分析

目的探讨急性心肌梗死并发心搏骤停的临床特点及抢救。方法对30例急性心肌梗死并发心搏骤停患者的临床资料进行回顾性分析。结果院内13例AMI并发心搏骤停患者经早期除颤复苏7例恢复自主循环，5例最终生存出院且全为男性患者、心功能I级。院前17例AMI并发心搏骤停患者经现场复苏3例恢复自主循环，最终全部死亡。结论全社会普及AMI及心肺复苏知识，120专业急救，早期除颤，院内高级抢救相结合才能提高AMI并发心搏骤停患者的生存率。     

院前心肺复苏115例结果分析

目的:通过分析院前心肺复苏(CPR)的结果,探讨提高院前心肺复苏成功率的途径。方法:对我院1998年至2002年救治的115例院前心搏骤停者,用Utstein模式进行回顾性统计和分析。结果:经复苏的104例心搏骤停者中,自主循环恢复(ROSC)有8例,复苏率为7.69％,其中2例存活至出院;对比呼救-到达现场间期(CRI)>6min和<6 min两组的复苏率有显著性差异,P<0.05;对比目击者是医务工作者和非医务工作者两组的复苏率有显著性差异,P<0.05 。结论:缩短CRI是提高院前心肺复苏成功率的关键途径;公民中普及CPR;提高医院急救技术和改善急救设备也不容忽视。     

心肺复苏后多器官功能障碍综合征的临床分析

目的 提高对心搏骤停复苏后发生多器官功能障碍综合征相关临床特点的认识,为其综合防治提供依据.方法 采用回顾性分析方法,收集吉林大学第二医院ICU收治的72例心搏骤停自主循环恢复患者的相关临床资料,主要包括心搏骤停地点、心搏骤停首次监测到的心律类型,心搏骤停原因,全身炎症反应综合征(SIRS)和多器官功能障碍综合征(MOOS)发生率,发生器官功能障碍的部位及个数,复苏成功率,存活出院率以及出院时脑功能分类评分(CPC).结果 心搏骤停自主循环恢复(ROSC)患者男女比例为1.18:1,院内和院外分别为55例和17例,比例为3.24:1.心搏骤停地点分布:院内以ICU、急诊室和手术室为主,共计41例,占74.55%(41/55);院外以来院途中和救护车中为主,共计11例,占64.71%(11/17).心搏骤停首次监测到的心律类型中可电击心律和非电击心律分别为38例和32例,比例为1.12:1;心搏骤停原因中心脏源性和非心脏源性因素分别为37例和35例,比例为1.06:1.72例心搏骤停ROSC患者中16例在24 h内死亡,56例心肺复苏成功,但其中51例在自主循环恢复后发生SIRS,42例相继合并NODS占75%(42/56),死亡27例占64.29%(27/42);受累器官依次为:脑38例(90.48%),心35例(83.33%),肺28例(66.67%).在56例心肺复苏成功患者中,MODS(-)组14例全部存活出院,MODS(+)组42例中存活15例,共计存活出院率为40.28%(29/72).MODS(-)组14例全部为CPC 1分,MODS(+)组CPC 1～2分7例、CPC 3～5分35例.两组患者性别和年龄比较差异无统计学意义(P>0.05),而脑功能分类评分和存活出院率比较差异均有统计学意义(P<0.01).结论 心搏骤停患者在自主循环恢复后SIRS发生较为普遍,随之合并MODS的发生率高,且心脑功能障碍位居受累器官前列,复苏后多器官功能障碍综合征是影响心搏骤停患者预后的重要因素.     

心肺复苏药物治疗的新进展

<正>心搏骤停(cardiac arrest,CA)是一种严重威胁人类生命的急症,无论是院外心搏骤停还是院内心搏骤停,自主循环恢复(return of spontaneous circulation,ROSC)率和存活率均较低~([1])。美国和欧洲的院内心搏骤停存活率为7%～26%~([2]),院外心搏骤停存活率为5%～20%~([3]),而北京院外心搏骤停和院内心搏骤停出院存活率仅为1.3%~([4])和     

院前心肺复苏临床分析研究

目的：探讨提高院前心肺复苏成功率的途径。方法：对我院1999年10月至2003年12月救治的48例院前心搏骤停者，用Utstein模式进行回顾性统计和分析。结果：经复苏的45例心搏骤停者中，自主循环恢复（ROSC）有4例，复苏率为8，89％，其中1例存活至出院；对比呼救-到达现场间期（CRI）〉6min和〈6min两组的复苏率有显著性差异，P〈0．05；对比目击者是医务工作者和非医务工作者两组的复苏率有显著性差异，P〈0．05。结论：缩短CRI是提高院前心肺复苏成功率的关键途径；公民中普及CPR对提高复苏成功率有重要意义；提高医院急救技术和改善急救设备也不容忽视。     

浦东新区心肺复苏成功患者预后影响因素分析

目的通过对上海市浦东新区近6年院外心肺复苏成功案例进行回顾性研究,分析影响心肺复苏成功的院外心搏骤停(out-of-hospital cardiac arrest,OHCA)患者预后的主要因素,以期为提高院外心肺复苏成功率提供依据。方法便利抽样选取2011年7月至2017年7月浦东新区院外心肺复苏成功的全部心搏骤停病例,采用Utstein模式对病例资料进行记录分析,采用SPSS 20.0软件对数据进行卡方检验和logistic回归。结果单因素分析显示,是否实施旁观者CPR、首次监测心律是否是可除颤心律以及肾上腺素用量≤5mg是24h存活和成活出院的可能影响因素(P0.05),男性以及心源性因素可能是影响成活出院率的有利因素(均P0.05);Logistic回归分析显示年龄是影响患者预后的独立因素(P0.05)。结论心肺复苏成功的OHCA患者预后不容乐观,须改善旁观者参与院前急救的现状,急救人员须缩短院前急救反应时间,实现更为早期的CPR和除颤,以改善患者预后。     

心肺复苏新指南在急诊呼吸心搏骤停病人中的应用

[目的]探讨心肺复苏新指南在急诊呼吸心搏骤停病人中的应用。[方法]回顾性分析2013年3月—2013年12月抢救的73例呼吸心搏骤停病人的临床资料。[结果]73例病人中恢复自主心搏24例,收治EICU 9例,收治重症监护室(ICU)10例,病人家属放弃抢救,自动出院5例,死亡49例;22例院内呼吸心搏骤停病人中恢复自主心搏10例;院外呼吸心搏骤停病人有无院前急救的抢救成功率比较,差异有统计学意义。[结论]对呼吸心搏骤停病人应及时、有效的进行心肺复苏,对非专业人员深入普及心肺复苏知识,加强医护人员急救知识培训及强化心肺复苏技能的训练,才能提高抢救成功率。     

院前心搏骤停患者心肺复苏后自主循环恢复与存活出院的相关影响因素研究

目的:以院前心搏骤停患者为病例对象,观察影响其心肺复苏(CPR)后自主循环恢复与存活出院的相关因素。方法:回顾性分析我院2018-01—2018-12期间行院前CPR的105例心搏骤停患者临床资料,对其进行跟踪随访,观察CPR后自主循环恢复与存活患者的病情特点,用Logistic回归方程计算,分析其相关影响因素。结果:本研究所选105例心搏骤停行CPR患者中,最终死亡78例(74.29%);自主循环恢复出院组与死亡组在基础疾病、心律类型、气管插管、心搏骤停原因、心脏停博耗时、群众性的CPR、院前CPR抢救时间、心肺复苏进行次数、肾上腺素注入剂量、入院至电除颤开始时间等一般资料上出现较大差异,数据对比差异有统计学意义(P0.05);将上述差异有统计学意义的资料代入Logistic回归方程进行计算,发现基础疾病、心律类型、气管插管、心搏骤停原因、心搏骤停耗时、群众性的CPR、院前CPR抢救时间、心肺复苏进行次数、肾上腺素注入剂量、入院至电除颤开始时间是影响心搏骤停患者CPR后自主循环恢复与否的相关因素。结论:影响院前心搏骤停患者心肺复苏后自主循环恢复与存活出院的因素很多,其中复苏前心律,尤其是室颤/室速、急救反应时间和复苏时间长短是影响患者存活的重要因素,而群众CPR与低剂量肾上腺素可能会提高院前CPR出院成功率。     

心肺复苏后亚低温脑保护治疗

在发达国家心搏骤停是院外骤死的主要原因,其发生率在0.04％～0.19％之间.大约14％ ～ 40％的院外心搏骤停患者经心肺复苏后可以恢复自主循环并收入院继续治疗,尽管医护人员恢复了一些患者自主循环,但大部分患者因严重缺氧性脑损害而昏迷,收入院的这些患者中仪仅只有7％ ～ 30％的患者可出院并伴有好的神经预后.     

体外心肺复苏启动前因素对患者预后的影响

目的:分析体外心肺复苏（extracorporeal cardiopulmonary resuscitation,ECPR）启动前因素对患者预后的影响,以探讨ECPR的干预时机和改进策略。方法:回顾性分析2018年7月至2021年4月在湖南师范大学附属第一医院（湖南省人民医院）行ECPR的29例患者。按患者是否存活出院分为生存组( n=13)及死亡组( n=16),分析两组常规心肺复苏（conventional cardiopulmonary resuscitation,CCPR）时间（开始心肺复苏到体外膜肺氧合运转的时间）、ECPR前初始心律、院外及院内心搏骤停的构成比、外院转运病例构成比。按CCPR时间分为≤45 min组、45~60 min组及>60 min组分别比较其出院存活率及持续自主循环恢复（sustained return of spontaneous circulation,ROSC）率。本院院内心搏骤停患者按心搏骤停（cardiac arrest,CA）发生地点分为本科室亚组和其他科室亚组,比较其存活率。 结果:29例患者总体生存率44.83%,体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）平均辅助时长114（33.5,142.5） h,CCPR平均时长60（44.5,80） min。生存组ECMO辅助时间（140.15±44.80）h较死亡组长（ P=0.001）,生存组CCPR时间明显低于死亡组（ P=0.010）。初始心律为可除颤心律组生存率更高（ P=0.010）。OHCA较IHCA患者病死率高（ P=0.020）。外院转运病例病死率高于本院病例（ P=0.025）。CCPR时间≤45min、45~60 min、>60 min三组患者出院生存率依次递减（ P=0.001）,ROSC率依次递减（ P=0.001)。本院院内心搏骤停患者,CA发生地点在本科室（急诊医学科）组与其他科室组生存率差异无统计学意义（ P=0.54）。 结论:ECPR出院存活率高于国内外报道的CCPR存活率,ECPR对难治性心搏骤停是有效的。ECPR的预后跟CCPR时间、CA初始心律、CA发生地点明显相关,提高ECPR存活率需加强宣教及团队建设。     

Significant factors in predicting sustained ROSC in paediatric patients with traumatic out-of-hospital cardiac arrest admitted to the emergency department

BACKGROUND: Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma. METHOD: This retrospective study comprised 115 paediatric patients (56 traumatic and 59 non-traumatic OHCA patients) aged younger than 18 years who had been admitted to the emergency department (ED) from January 2000 to December 2004. We analysed the demographic data and the factors that may have influenced sustained ROSC in the group of OHCA paediatric patients with trauma. The non-trauma group was established as a control group. Survival analysis was used to compare differences in survival rate between trauma and non-trauma OHCA patients. Receiver operating characteristic (ROC) analysis was used to determine the significant in-hospital CPR duration related to sustained ROSC. RESULTS: Initial cardiac rhythm on arrival (P=0.005) and the duration of in-hospital CPR (P<0.001) were significant factors. Patients with PEA or VF had higher rate of sustained ROSC than those with asystole (PEA: P=0.003, VF: P=0.03). In the survival analysis, OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008). Based on the ROC analysis, the cut-off values of in-hospital CPR duration were 25min in OHCA paediatric patients with trauma. CONCLUSION: Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.     

A national resuscitation registry of out-of-hospital cardiac arrest in Germany—A pilot study

Background

Survival rate after out-of-hospital cardiac arrest (OHCA) has not significantly increased over the last decade. However, survival rate has been used as a quality benchmark for many emergency medical services. A uniform resuscitation registry may be advantageous for quality management of cardiopulmonary resuscitation (CPR). This study was conducted to evaluate the establishment of a national CPR registry in Germany.

Materials and methods

A prospective cohort study was performed that included 469 patients who experienced OHCA requiring CPR in the metropolitan area of Dortmund, Germany. Cardiac arrest was defined as concomitant appearance of unconsciousness, apnoea or gasping and pulselessness. All data were collected via a secure and confidential paper-based method as the data set ‘Preclinical care’.

Results

Quality of data was classified as ‘good’ in 33.4%, ‘moderate’ in 48.4%, and ‘bad’ in 18.2% of the patients, respectively. Sixty-two percent had OHCA in private residences, 24% of the patients had a first monitored rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT), 35.2% had return of spontaneous circulation (ROSC) on scene, and patients presenting VF/VT as the first monitored rhythm had higher ROSC rates (51.3%) compared to patients with asystole (22.6%).

Conclusion

The data set ‘Preclinical care’ proved to be congruent with the Utstein style, provided further information for national and international comparisons, and enabled a detailed analysis. Optimisation of data collection and introduction of strict control mechanisms may further improve data quality.     

Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support

Aim

Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) for in-hospital cardiac arrest (IHCA) patients has been assigned a low-grade recommendation in current resuscitation guidelines. This study compared the outcomes of IHCA and out-of-hospital cardiac arrest (OHCA) patients treated with ECLS.

Methods

A total of 77 patients were treated with ECLS. Baselines characteristics and outcomes were compared for 38 IHCA and 39 OCHA patients.

Results

The time interval between collapse and starting ECLS was significantly shorter after IHCA than after OHCA (25 (21-43) min versus 59 (45-65) min, p < 0.001). The weaning rate from ECLS (61% versus 36%, p = 0.03) and 30-day survival (34% versus 13%, p = 0.03) were higher for IHCA compared with OHCA patients. IHCA patients had a higher rate of favourable neurological outcome compared to OHCA patients, but the difference was not statistically significant (26% versus 10%, p = 0.07). Kaplan-Meier analysis showed improved 30-day and 1-year survival for IHCA patients treated with ECLS compared to OHCA patients who had ECLS. However, multivariate stepwise Cox regression model analysis indicated no difference in 30-day (odds ratio 0.94 (95% confidence interval 0.68-1.27), p = 0.67) and 1-year survival (0.99 (0.73-1.33), p = 0.95).

Conclusion

CPR with ECLS led to more favourable patient outcomes after IHCA compared with OHCA in our patient group. The difference in outcomes for ECLS after IHCA and OHCA disappeared after adjusting for patient factors and the time delay in starting ECLS.     

Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – A comparison with that for extracorporeal rescue for in-hospital cardiac arrest

Purpose

The aim was to investigate the effects of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) and compare the results with those of in-hospital cardiac arrest (IHCA).

Methods

We analyzed our extracorporeal membrane oxygenation (ECMO) results for patients who received ECPR for OHCA or IHCA in the last 5 years. Pre-arrest, resuscitation, and post-resuscitative data were evaluated.

Results

In the last 5 years, ECPR was used 230 times for OHCA (n = 31) and IHCA (n = 199). The basic demographic data showed significant differences in age, cardiomyopathy, and location of the initial CPR. Duration of ischemia was shorter in the IHCA group (44.4 ± 24.7 min vs. 67.5 ± 30.6 min, p < 0.05). About 50% of each group underwent a further intervention to treat the underlying etiology. ECMO was maintained for a shorter duration in the OHCA patients (61 ± 48 h vs. 94 ± 122 h, p < 0.05). Survival to discharge was similar in the two groups (38.7% for OHCA vs. 31.2% for IHCA, p > 0.05), as was the favorable outcome rate (25.5% for OHCA vs. 25.1% for IHCA, p > 0.05). Survival was acceptable (about 33%) in both groups when the duration of ischemia was no longer than 75 min.

Conclusions

In addition to having a beneficial effect in IHCA, ECPR can lead to survival and a positive neurological outcome in selected OHCA patients after prolonged resuscitation. Our results suggest that further investigation of the use of ECMO in OHCA is warranted.     

山莨菪碱对心搏骤停大鼠复苏的影响

目的 观察山莨菪碱对心搏骤停大鼠自主循环恢复(ROSC)及复苏成功率的影响,旨在探寻心肺复苏的新方法.方法 采用盲法将45只成年SD大鼠随机分为对照组、肾上腺素组和肾上腺素+山莨菪碱组(联用组),每组15只.实验采用经食道心脏起搏诱发心室纤颤或心室静止,使用电动机械胸外按压机进行胸外按压.盲法给药,肾上腺素剂量200 μg/kg,山莨菪碱为10 mg/kg,对比各组ROSC率及复苏成功率.结果 联用组ROSC率(93.3%比46.7%)、复苏成功率(80.0%比33.3%)及3 h存活率(83.3%比20.O%)均高于肾上腺素组,差异有统计学意义(P均<0.05);对照组仅1只大鼠ROSC.ROSC即刻肾上腺素组平均动脉压(MAP)明显高于联用组(P<0.05);ROSC后两组MAP均呈逐渐下降趋势,且自5 min开始,肾上腺素组MAP明显低于联用组,至ROSC后30 min,两组比较差异仍有统计学意义(P均<0.05).结论 肾上腺素合用山莨菪碱可以提高心搏骤停ROSC率和复苏成功率.     

The association between chest compression release velocity and outcomes from out-of-hospital cardiac arrest

BackgroundPrevious studies have demonstrated significant relationships between cardiopulmonary resuscitation (CPR) quality metrics and survival to hospital discharge from out-of-hospital cardiac arrest (OHCA). Recently, it has been suggested that a new metric, chest compression release velocity (CCRV), may be associated with improved survival from OHCA.Methods and resultsWe performed a retrospective review of all treated adult OHCA occurring over a two year period beginning January 1, 2012. CPR metrics were abstracted from accelerometer measurements during each resuscitation. Multivariable regression analysis was used to examine the impact of CCRV on survival to hospital discharge. Secondary outcome measures were the impact of CCRV on return of spontaneous circulation (ROSC) and neurologically intact survival (MRS ≤ 3). Among 1800 treated OHCA, 1137 met inclusion criteria. The median (IQR) age was 71.6 (60.6, 82.3) with 724 (64%) being male. The median (IQR) CCRV (mm/s) amongst 96 survivors was 334.5 (300.0, 383.2) compared to 304.0 (262.6, 354.1) in 1041 non survivors (p < 0.001). When adjusted for Utstein variables, the odds of survival to hospital discharge for each 10 mm/s increase in CCRV was 1.02 (95% CI: 0.98, 1.06). Similarly the odds of ROSC and neurologically intact survival were 1.01 (95% CI: 0.99, 1.03) and 1.02 (95% CI: 0.98, 1.06), respectively.ConclusionsWhen adjusted for Utstein variables, CCRV was not significantly associated with outcomes from OHCA. Further research in other EMS systems is required to clarify the potential impact of this variable on OHCA survival.     

Emergency Department inter-hospital transfer for post-cardiac arrest care: Initial experience with implementation of a regional cardiac resuscitation center in the United States

Objective

The American Heart Association recently recommended regional cardiac resuscitation centers (CRCs) for post-resuscitation care following out-of-hospital cardiac arrest (OHCA). Our objective was to describe initial experience with CRC implementation.

Methods

Prospective observational study of consecutive post-resuscitation patients transferred from community Emergency Departments (EDs) to a CRC over 9 months. Transfer criteria were: OHCA, return of spontaneous circulation (ROSC), and comatose after ROSC. Incoming patients were received and stabilized in the ED of the CRC where advanced therapeutic hypothermia (TH) modalities were applied. Standardized post-resuscitation care included: ED evaluation for cardiac catheterization, TH (33–34 °C) for 24 h, 24 h/day critical care physician support, and evidence-based neurological prognostication. Prospective data collection utilized the Utstein template. The primary outcome was survival to hospital discharge with good neurological function [Cerebral Performance Category 1 or 2].

Results

Twenty-seven patients transferred from 11 different hospitals were included. The majority (21/27 [78%]) had arrest characteristics suggesting poor prognosis for survival (i.e. asystole/pulseless electrical activity initial rhythm, absence of bystander cardiopulmonary resuscitation, or an unwitnessed cardiac arrest). The median (IQR) time from transfer initiation to reaching TH target temperature was 7 (5–13) h. Ten (37%) patients survived to hospital discharge, and of these 9/10 (90% of survivors, 33% of all patients) had good neurological function.

Conclusions

Despite a high proportion of patients with cardiac arrest characteristics suggesting poor prognosis for survival, we found that one-third of CRC transfers survived with good neurological function. Further research to determine if regional CRCs improve outcomes after cardiac arrest is warranted.     

Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China

AimsThis retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest.MethodsACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes.ResultsThe total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16–30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16–30 min), Killip ≤ II, and CCI ≤ 2.ConclusionYounger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.     

Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest

Background

There are few data comparing outcome and the utility of severity of illness scoring systems following intensive care after out-of-hospital (OHCA), in-hospital (IHCA) and intensive care unit (ICUCA) cardiac arrest. We investigated survival, factors associated with survival and the correlation and accuracy of general and specific scoring systems, including the Apache III score and the OHCA score in OHCA, IHCA and ICUCA patients.

Material and methods

Prospective analysis of data on all cardiac arrest patients treated in a tertiary hospital between August 1st 2008 and July 30th 2010. Collected data included resuscitation and post-resuscitation care data as defined by the Utstein Guidelines, Apache III on admission and the OHCA score on admission in OHCA and IHCA patients and after the arrest in ICUCA patients. Statistical methods were used to identify factors associated with outcome and the predictive ability and correlation of the aforementioned scores.

Results

Of a total of 3931 patients treated in the ICU, 51 were admitted following OHCA, 50 following IHCA and 22 suffered an ICUCA and had sustained return of spontaneous circulation (ROSC). Survival at 30 days was highest among ICUCAs (67%) followed by IHCAs (38%) and OHCAs (29%). Using multivariate analysis delay ROSC was the only independent predictor of survival. The OHCA score performed with moderate accuracy for predicting 30-day mortality (area under the curve 0.77 [0.69–0.86] and was slightly better than the Apache III score 0.71 (0.61–0.80). Using multiple logistic regression the Apache III and the OHCA score were both independent predictors of hospital survival and correlation between these two scores was weak (correlation coefficient of 0.244).

Conclusions

Latency to ROSC seems to be the most important determinant of survival in patients following ICU care after a cardiac arrest in this single center trial. The OHCA score and the Apache III score offer moderate predictive accuracy in ICU cardiac arrest patients but correlated weakly with each other. Illness severity adjustment for cardiac arrest patients in ICU should include features of both these scoring systems.