背景:相对于其他住院患者,创伤患者更年轻,合并症更少,但该人群院内心肺骤停(IHCA)伴心肺复苏(CPR)的发生率和结局尚不清楚.因此,我们的目的是调查与IHCA术后创伤患者生存相关的因素,以检验与其他住院患者相比的假设,IHCA创伤患者生存率提高。
方法:回顾性回顾2017年至2019年创伤质量改善计划数据库中IHCA合并CPR的患者。主要结果是生存至出院。次要结果是院内并发症,住院时间,重症监护室住院时间,和呼吸机日。数据与单变量和多变量分析比较,P<0.05。
结果:在22,346,677例精神创伤患者中,14,056(0.6%)接受了CPR。在所有住院患者的全国样本中,四千三百七十七(31.1%)存活到出院,而不是26.4%(P<0.001)。在创伤患者中,中位年龄为55岁,大多数为男性(72.2%)。女性死亡率高于男性(70.3%对68.3%,P=0.026)。多因素回归分析显示,年龄大1.01(95%置信区间(CI)1.01-1.02),西班牙裔种族1.21(95%CI1.04-1.40),穿透性创伤1.51(95%CI1.32-1.72)是死亡的危险因素,白种人是保护因素0.36(95%CI0.14-0.89)。
结论:这是第一项研究表明,IHCA合并CPR的发生率约为1000例创伤住院患者中的6例,31%的人出院后存活下来。高于其他住院患者。年龄,性别,种族,种族差异也影响生存。
BACKGROUND: Relative to other hospitalized patients, trauma patients are younger with fewer comorbidities, but the incidence and outcomes of in-hospital cardiopulmonary arrest (IHCA) with cardiopulmonary resuscitation (CPR) in this population is unknown. Therefore, we aimed to investigate factors associated with survival in trauma patients after IHCA to test the hypothesis that compared to other hospitalized patients, trauma patients with IHCA have improved survival.
METHODS: Retrospective review of the Trauma Quality Improvement Program database 2017 to 2019 for patients who had IHCA with CPR. Primary outcome was survival to hospital discharge. Secondary outcomes were in-hospital complications, hospital length of stay, intensive care unit length of stay, and ventilator days. Data were compared with univariate and multivariate analyses at P < 0.05.
RESULTS: In 22,346,677 admitted trauma patients, 14,056 (0.6%) received CPR. Four thousand three hundred seventy-seven (31.1%) survived to discharge versus 26.4% in a national sample of all hospitalized patients (P < 0.001). In trauma patients, median age was 55 y, the majority were male (72.2%). Mortality was higher for females versus males (70.3% versus 68.3%, P = 0.026). Multivariate regression showed that older age 1.01 (95% confidence interval (CI) 1.01-1.02), Hispanic ethnicity 1.21 (95% CI 1.04-1.40), and penetrating trauma 1.51 (95% CI 1.32-1.72) were risk factors for mortality, while White race was a protective factor 0.36 (95% CI 0.14-0.89).
CONCLUSIONS: This is the first study to show that the incidence of IHCA with CPR is approximately six in 1000 trauma admissions and 31% survive to hospital discharge, which is higher than other hospitalized patients. Age, gender, racial, and ethnic disparities also influence survival.