背景:在美国,无脉性电活动(PEA)和心搏停止占初始住院心脏骤停(IHCA)节律的81%。在复苏研究和实践中,这些“不可电击”节律通常被组合在一起。我们假设PEA和心搏停止是具有明显特征的初始IHCA节律。
方法:这是一项观察性队列研究,使用前瞻性收集的全国GetWithTheGuidelines®-Resuscitation注册表。包括2006年至2019年之间具有IHCA指数和PEA或心搏停止的初始节律的成年患者。PEA患者与心搏停止与停搏前的特征进行了比较,复苏实践,和结果。
结果:我们确定了147,377(64.9%)PEA和79,720(35.1%)心搏性IHCA。心搏停止在非遥测病房中有更多的逮捕(20,530/147,377[13.9%]PEA与17,618/79,720[22.1%]心搏停止)。心搏停止的ROSC调整后几率降低3%(91,007[61.8%]PEA与44,957[56.4%]心搏停止,aOR0.97,95CI0.96-0.97,P<0.01);生存到出院没有差异(28,075[19.1%]PEA与14,891[18.7%]心搏停止,OR1.00,95CI1.00-1.01,P=0.63)。无ROSC的患者的复苏持续时间较短(PEA中29.8[±22.5]分钟与心搏停止26.2[±21.5]分钟,校正平均差-3.0595CI-3.36--2.74,P<0.01)。解释患有初始PEA节律的IHCA患者与心搏停止患者的患者和复苏水平存在差异。PEA逮捕在受监控的环境中更为常见,并且接受了更长的复苏。尽管PEA与较高的ROSC率相关,生存到出院没有差异。
Pulseless electrical activity (PEA) and asystole account for 81% of initial in-hospital cardiac arrest (IHCA) rhythms in the U.S.A. These \"non-shockable\" rhythms are often grouped together in resuscitation research and practice. We hypothesized that PEA and asystole are distinct initial IHCA rhythms with distinguishing features.
This was an observational cohort study using the prospectively collected nationwide Get With The Guidelines®-Resuscitation registry. Adult patients with an index IHCA and an initial rhythm of PEA or asystole between the years of 2006 and 2019 were included. Patients with PEA vs. asystole were compared with respect to pre-arrest characteristics, resuscitation practice, and outcomes.
We identified 147,377 (64.9%) PEA and 79,720 (35.1%) asystolic IHCA. Asystole had more arrests in non-telemetry wards (20,530/147,377 [13.9%] PEA vs. 17,618/79,720 [22.1%] asystole). Asystole had 3% lower adjusted odds of ROSC (91,007 [61.8%] PEA vs. 44,957 [56.4%] asystole, aOR 0.97, 95%CI 0.96-0.97, P < 0.01); there was no statistically significant difference in survival to discharge (28,075 [19.1%] PEA vs. 14,891 [18.7%] asystole, aOR 1.00, 95%CI 1.00-1.01, P = 0.63). Duration of resuscitation for those without ROSC were shorter for asystole (29.8 [±22.5] minutes in PEA vs. 26.2 [±21.5] minutes in asystole, adjusted mean difference -3.05 95%CI -3.36--2.74, P < 0.01).
Patients suffering IHCA with an initial PEA rhythm had patient and resuscitation level differences from those with asystole. PEA arrests were more common in monitored settings and received longer resuscitations. Even though PEA was associated with higher rates of ROSC, there was no difference in survival to discharge.