In-hospital cardiac arrest in hospitals with mature rapid response systems - a multicentre, retrospective cohort study

RESUSCITATION

卷:149

Article

Tirkkonen, Joonas^1,2,3,4  Skrifvars, Markus B.^5,6  Parr, Michael^3,4,7  Tamminen, Tero^6,8  Aneman, Anders^3,4,7,9 

[1] Tampere Univ Hosp, Dept Intens Care Med, POB 2000, FI-33521 Tampere, Finland

[2] Tampere Univ Hosp, Dept Emergency Anaesthesia & Pain Med, POB 2000, FI-33521 Tampere, Finland

[3] Liverpool Hosp, Intens Care Unit, Sydney, NSW, Australia

[4] Cnr Elizabeth & Goulburn Sts, Liverpool 2170, NSW, England

[5] Univ Helsinki, Dept Emergency Care & Serv, POB 22, FI-00014 Helsinki, Finland

[6] Helsinki Univ Hosp, POB 22, FI-00014 Helsinki, Finland

[7] Univ New South Wales, Liverpool Hosp, South Western Sydney Clin Sch, Sydney, NSW, Australia

[8] Univ Helsinki, Div Intens Care, Dept Anaesthesiol Intens Care & Pain Med, POB 22, FI-00014 Helsinki, Finland

[9] Macquarie Univ, Fac Med & Hlth Sci, 75 Talavera Rd, Sydney, NSW 2109, Australia

关键词: In-hospital cardiac arrest;    Rapid response team;    Rapid response system;   

DOI  :  10.1016/j.resuscitation.2020.02.022

来源: Elsevier

【 摘 要 】

Aim: To investigate in-hospital cardiac arrests (IHCAs) according to the Ustein template in hospitals with mature systems utilizing rapid response teams (RRTs), with a special reference to preceding RRT factors and factors associated with a favourable neurological outcome (cerebral performance category (CPC) 1-2) at hospital discharge. Methods: Multicentre, retrospective cohort study between 2017-2018 including two Finnish and one Australian university affiliated tertiary hospitals. Results: A total 309 IHCAs occurred with an incidence of 0.78 arrests per 1000 hospital admissions. The median age of the patients was 72 years, 63% were male and 73% had previously lived a fully independent life with a median Charlson comorbidity index of two. Before the IHCA, 16% of the patients had been reviewed by RRTs and 26% of the patients fulfilled RRT activation criteria in the preceding 8 h of the IHCA. Return of spontaneous circulation was achieved in 53% of the patients and 28% were discharged from hospital with CPC 1-2. In a multivariable model, younger age, no pre-arrest RRT criteria, arrest in normal work hours, witnessed arrest and shockable initial rhythm were independently associated with CPC 1-2 at hospital discharge. Conclusions: In hospitals with mature rapid response systems most IHCA patients live a fully independent life with low burden of comorbid diseases before their hospital admission, the IHCA incidence is low and outcome better than traditionally believed. Deterioration before IHCA is present in a significant number of patients and improved monitoring and earlier interventions may further improve outcomes.

【 授权许可】

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