目的:围手术期院内心脏骤停(围手术期IHCA)可能比病房中的IHCA有更好的结果,由于加强监测和更快的响应。然而,缺乏对其长期结果的定量比较,对预测构成挑战。
方法:这项回顾性多中心研究包括2018年1月至2022年3月期间从手术室/康复或病房入院并诊断为心脏骤停的成人重症监护病房(ICU)。我们使用ANZICS成人患者数据库中175个ICU的数据。主要结果是长达4年的生存时间。我们使用Cox比例风险模型校正序贯器官衰竭评估(SOFA)评分,年龄,性别,合并症,医院类型,入住ICU的治疗限制,ICU治疗。亚组分析检查年龄(≥65岁),插管在第一个24小时内,选修vs.紧急入院,出院后生存。
结果:在702,675名ICU住院患者中,纳入5,659个IHCA(围手术期IHCA38%;WardIHCA62%)。围手术期IHCA组较年轻,不那么脆弱,更少的合并症。围手术期IHCA在心血管疾病后入住ICU的患者中最常见,胃肠,或者外伤手术.围手术期IHCA组的4年生存率更长(59.9%vs.33.0%,p<0.001)比WardIHCA组,即使经过校正(校正后的风险比[HR]:0.63,95%置信区间[CI]0.57-0.69)。这在所有亚组中是一致的。值得注意的是,围手术期IHCA的老年患者比WardIHCA的年轻和老年患者存活时间更长.
结论:围手术期IHCA后入住ICU的患者比WardIHCA的生存期更长。未来关于IHCA的研究应该区分这些患者。
OBJECTIVE: Perioperative in-hospital cardiac arrests (Perioperative IHCAs) may have better outcomes than IHCAs in the ward (Ward IHCAs), due to enhanced monitoring and faster response. However, quantitative comparisons of their long-term outcomes are lacking, posing challenges for prognostication.
METHODS: This retrospective multicentre study included adult intensive care unit (ICU) admissions from theatre/recovery or wards with a diagnosis of cardiac arrest between January 2018 and March 2022. We used data from 175 ICUs in the ANZICS adult patient database. The primary outcome was a survival time of up to 4 years. We used the Cox proportional hazards model adjusted for Sequential Organ Failure Assessment (SOFA) score, age, sex, comorbidities, hospital type, treatment limitation on admission to the ICU, and ICU treatments. Subgroup analyses examined age (≥ 65 years), intubation within the first 24 h, elective vs. emergency admission, and survival on discharge.
RESULTS: Of 702,675 ICU admissions, 5,659 IHCAs were included (Perioperative IHCA 38%; Ward IHCA 62%). Perioperative IHCA group were younger, less frail, and less comorbid. Perioperative IHCA were most frequent in patients admitted to ICU after cardiovascular, gastrointestinal, or trauma surgeries. Perioperative IHCA group had longer 4-year survival (59.9% vs. 33.0%, p < 0.001) than the Ward IHCA group, even after adjustments (adjusted hazard ratio [HR]: 0.63, 95% confidence interval [CI] 0.57-0.69). This was concordant across all subgroups. Of note, older patients with Perioperative IHCA survived longer than both younger and older patients with Ward IHCA.
CONCLUSIONS: Patients admitted to the ICU following Perioperative IHCA had longer survival than Ward IHCA. Future studies on IHCA should distinguish these patients.