Clinical Characteristics Of Adults With In-hospital Cardiac Arrest And Factors Associated With Outcomes Of Resuscitation

Cardiac Arrest（CA） is the leading cause of death worldwide.Cardiopulmonary resuscitation（CPR）is the most effective way to rescue patients with CA.Return of Spontaneous Circulation（ROSC）refers to the patients with CA after CPR rescue measures return of spontaneous heart rhythm and circulation,which is an important indicator for clinical prognosis assessment of patients with cardiac arrest.Key factors affecting cardiac arrest survival include timely identification and activation of the pre-hospital emergency system,early cardiopulmonary resuscitation and rapid defibrillation（if applicable）,and timely advanced cardiac life support.Despite advances in cardiopulmonary resuscitation,electrical defibrillation,and advanced life support techniques,the return of spontaneous circulation is still less than ideal,even for patients with CA in the hospital care unit.Cardiopulmonary resuscitation remains one of the most challenging topics in emergency and critical care medicine.The study of the adult return of spontaneous circulation and prognostic factors is conducive to improving the success rate of CPR in patients.In this paper,the clinical characteristics of CA patients in the hospital adult care unit and related factors of CPR success rate were summarized,providing a reference for the treatment of CA patients in the hospital care unit.Objective:To analyze the clinical characteristics of patients with cardiac arrest in the adult intensive care unit of the First Hospital of Jilin University and to explore the factors associated with the success rate of cardiopulmonary resuscitation in the adult intensive care unitMethods:The clinical data of patients with cardiac arrest in the coronary care unit,emergency intensive care unit,and intensive care unit of the First Hospital of Jilin University from September 1,2019,to December 31,2020,were retrospectively analyzed.The study subjects were determined by inclusion and exclusion criteria.According to the outcome of resuscitation,the patients were divided into ROSC group and non-ROSC group,the survival to discharge group and the death group,and the clinical characteristics of the groups were compared.The primary outcome measures were ROSC rate,and the secondary outcome measures were the CA survival to discharge rate,neurological function score at discharge,and 30-day survival after CA.χ~2,Fisher’s,Mann-Whitney U tests were used for comparison between groups,and univariate and multivariate logistic regression analyses were used to determine the independent factors associated with ROSC and survival to discharge.Results:1.Overall situation of study subjects:A total of 351 patients were included in this study,including 206 males（58.7%）and 145 females（41.3%）,with a male to female ratio of 1.42:1.The age ranged from 20 to 99,with a median age was 65（53-73 years old）.There were 191（54.4%）patients with CA caused by cardiogenic diseases.There were 267（76.0%）patients with CA whose initial rhythm was non-defibrillation rhythm（ventricular asystole、pulseless electrical activity）.After CPR,152 patients（43.3%）reached ROSC,42 patients（12%）were survived to discharged from the hospital,33 patients（9.4%）were discharged with good neurological function,and 28 patients（8.0%）survived 30 days.2.Comparison between the ROSC group and the non-ROSC group:Compared with non-ROSC group,the ROSC group had younger onset age（63 years vs.67 years,P=0.009）,lower cumulative epinephrine dose（2mg vs.9mg,P<0.001）,and lower incidence of coronary heart disease（46.7%vs.57.8%,P=0.039）.In the ROSC group,initial defibrillation rhythm（34.2%vs.16.1%,P<0.001）,defibrillation rhythm occurred during rescue（43.4%vs.28.1%,P=0.003）,duration of CPR≤30min（96.1%vs.45.2%,P<0.001）,electrical defibrillation（40.8%vs.26.1%,P=0.004）,and emergency endotracheal intubation（38.8%vs.19.6%,P<0.001）were significantly higher than those in the non-ROSC group.There were no statistically significant differences between the ROSC group and the non-ROSC group in sex,smoking history,drinking history,diabetes,hypertension,CA occurrence time and CA etiology（all P≥0.05）.3.Comparison between survival to discharge group and death group:compared with death group,the survival to discharge group had a lower mean cumulative dose of epinephrine（0mg vs.6mg,P<0.001）;cardiogenic diseases（85.7%vs.50.2%,P<0.001）,initial defibrillation rhythm（64.3%vs.18.4%,P<0.001）,defibrillation rhythm occurred during rescue（78.6%vs.28.8%,P<0.001）,duration of CPR≤30 minutes（95.2%vs.63.4%,P<0.001）and electrical defibrillation（73.8%vs.26.9%,P<0.001）were significantly higher than those in the death group.There were no statistically significant differences in sex,age,smoking history,drinking history,diabetes,hypertension,occurrence time of CA,and emergency tracheal intubation between the survival discharge group and the death group（all P≥0.05）.4.Univariate logistic regression analysis was associated with ROSC and survival to discharge:Univariate logistic regression analysis showed that coronary heart disease（OR=1.56,95%CI 1.02-2.39,P=0.040）,non-defibrillation heart rhythm（OR=2.714,95%CI 1.637-4.498,P<0.001）,no defibrillation rhythm during rescue（OR=1.96,95%CI 1.26-3.06,P=0.003）,no electric defibrillation（OR=1.95,95%CI1.24-3.06,P=0.004）and no emergency endotracheal intubation（OR=2.60,95%CI1.61-4.20,P<0.001）reduced the possibility of ROSC,and young age（OR=0.98,95%CI 0.97-0.99,P=0.018）,CPR duration≤30min（OR=0.03,95%CI 0.01-0.08,P<0.001）,small cumulative dose of epinephrine（OR=0.75,95%CI 0.70-0.80,P<0.001）increased the likelihood of ROSC.Non-cardiogenic cause（OR=5.96,95%CI 2.44-14.55,P<0.001）,non-defibrillation heart rhythm（OR=7.96,95%CI 3.98-15.92,P<0.001）,no electric defibrillation（OR=7.67,95%CI 3.69-15.96,P<0.001）,and no defibrillation rhythm during rescue（OR=9.06,95%CI 4.18-19.72,P<0.001）reduced the possibility of survival to discharge.CPR duration≤30min（OR=0.09,95%CI0.02-0.37,P=0.001）and small cumulative dose of epinephrine（OR=0.57,95%CI0.45-0.71,P<0.001）increased the possibility of survival to discharge.5.Multivariate Logistic regression analysis was associated with ROSC and survival to discharge:1)CPR duration≥30min（OR=14.048,95%CI5.354-36.861,P<0.001）was an independent risk factor for ROSC.Young age（OR=0.974,95%CI0.955-0.995,P=0.013）,emergency endotracheal intubation（OR=0.270,95%CI 0.137-0.530,P<0.001）,small cumulative dose of epinephrine（OR=0.787,95%CI 0.730-0.848,P<0.001）were independent protective factors of ROSC.2)CPR duration≥30min（OR=12.754,95%CI 2.953-55.083,P=0.001）was an independent risk factor for survival to discharge.Defibrillation rhythm（OR=0.171,95%CI 0.071-0.415,P<0.001）and cardiogenic etiology（OR=0.346,95%CI 0.124-0.963,P=0.042）were independent protective factors for survival and discharge.Conclusion:1.Patients with adult cardiac arrest and CPR in the hospital care unit are mostly elderly males.The etiology of CA is cardiogenic diseases,and the initial heart rhythm is mainly non-defibrillation heart rhythm.The ROSC rate was 43.3%,the survival rate was 12%,the discharge rate was 9.4%,and the 30-day survival rate was 8.0%.2.Age,emergency endotracheal intubation,and coronary heart disease were associated with ROSC.Cardiogenic causes were associated only with survival to discharge.The duration of CPR,cumulative dose of epinephrine,initial rhythm,electrical defibrillation,and defibrillation rhythm occurred during rescue were associated with ROSC and survival to discharge,and duration of CPR>30min was an independent risk factor.Clinical attention should be paid to these factors to improve the outcome of cardiopulmonary resuscitation.