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covid-19重症患者发生院内心脏骤停的危险因素
作者:小柯机器人 发布时间:2020/10/7 23:31:05

美国密歇根大学Salim S Hayek团队分析了covid-19重症患者发生院内心脏骤停的危险因素。2020年9月30日,该成果发表在《英国医学杂志》上。

为了评估covid-19重症患者与院内心脏骤停和心肺复苏相关的发生率、危险因素和预后,研究组进行了一项多中心队列研究,在全美68家不同医院的重症监护室中招募实验室确诊的covid-19重症成人。主要结局指标为进入重症监护室(ICU)后14天内的院内心脏骤停和院内死亡率。

在5019名covid-19重症患者中,14.0%发生了院内心脏骤停,其中57.1%接受了心肺复苏。与未发生院内心脏骤停的患者相比,院内心脏骤停的患者年龄更大、合并症更多、更可能住在重症监护病房较少的医院。接受心肺复苏术的患者比未接受心肺复苏术的患者更年轻,平均年龄分别为61岁和67岁。

心肺复苏时最常见的节律是无脉搏电活动(49.8%)和心搏停止(23.8%)。在接受心肺复苏的400例患者中,有48例(12.0%)存活至出院,而神经系统正常或轻度受损的患者仅7.0%(28/400)存活至出院。存活出院率因年龄而异,年龄在45岁以下的患者存活率为21.2%,而80岁以上的患者仅为2.9%。

总之,心脏骤停在covid-19的重症患者中很常见,且与较差的生存率有关,尤其是老年患者。

附:英文原文

Title: In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

Author: Salim S Hayek, Samantha K Brenner, Tariq U Azam, Husam R Shadid, Elizabeth Anderson, Hanna Berlin, Michael Pan, Chelsea Meloche, Rafey Feroz, Patrick O’Hayer, Rayan Kaakati, Abbas Bitar, Kishan Padalia, Daniel Perry, Pennelope Blakely, Shruti Gupta, Shahzad Shaefi, Anand Srivastava, David M Charytan, Anip Bansal, Mary Mallappallil, Michal L Melamed, Alexandre M Shehata, Jag Sunderram, Kusum S Mathews, Anne K Sutherland, Brahmajee K Nallamothu, David E Leaf

Issue&Volume: 2020/09/30

Abstract:

Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19).

Design Multicenter cohort study.

Setting Intensive care units at 68 geographically diverse hospitals across the United States.

Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19.

Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality.

Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older.

Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

DOI: 10.1136/bmj.m3513

Source: https://www.bmj.com/content/371/bmj.m3513

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj