由于可震动节律的原因,心脏骤停在除动前给予上腺素的医院变化
Colten Stewart1, Paul S Chan2,3, Kevin Kennedy2
1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Critical care medicine
|March 19, 2024
概括
在可震动性心脏骤停的情况下,在除动之前给予上腺素是常见的,并因医院而异. 这种做法的更高率与更低的生存率有关,这表明需要遵循立即除指南.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 医疗保健服务研究 医疗服务研究
背景情况:
- 先进的心脏生命支持指南建议在可震动的医院内心脏骤停 (IHCA) 时立即进行除动器.
- 然而,在第一次除前给药上腺素是一种常见的做法,尽管与较低的患者生存率有关.
- 医院之间这种做法的变化及其对医院级IHCA存活率的影响仍然不清楚.
研究的目的:
- 为了研究可震动的IHCA,在除前对上腺素的给药率的医院变化.
- 确定这些医院水平率与IHCA存活率之间的关联.
主要方法:
- 一项观察性队列研究使用了来自513家医院的数据进行,这些医院在Get With The Guidelines复苏注册表中.
- 这项研究包括37,668名患有IHCA的成年患者和2000年至2019年之间的初始可震动节律.
- 多变量等级回归被用来分析医院在除前给予上腺素的变化及其与风险调整后生存率的关联.
主要成果:
- 在医院中观察到除前上腺素的显著变化,中位数为18.8% (范围:0-68.8%).
- 主要的教学状态和年度IHCA量影响了早期上腺素的医院率.
- 在除之前使用上腺素的比率较高的医院,风险调整后的存活率相比较低 (Q1: 44.3% vs. Q4: 40.3%).
结论:
- 在可震动的IHCA中,在除动之前注射上腺素的做法很普遍,在美国医院之间有很大的差异.
- 这种做法在医院的更高率与医院水平风险调整后生存率明显较低有关.
- 需要紧急努力,以促进遵守指导方针,强调立即除,并避免在易受冲击的IHCA中早期给予上腺素.
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