Long-term survival comparison of patients admitted to the intensive care unit following in-hospital cardiac arrest in perioperative and ward settings. A multicentre retrospective cohort study.

Autor: Ueno R; Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia. ryo.ueno@monash.edu.; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia. ryo.ueno@monash.edu.; Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia. ryo.ueno@monash.edu., Chan R; Department of Anaesthesia and Pain Medicine, The Canberra Hospital, Canberra, Australia., Reddy MP; Department of Anaesthesia and Pain Medicine, Nepean Hospital, Sydney, NSW, Australia.; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia.; Department of Intensive Care, North Canberra Hospital, Canberra, Australia., Jones D; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia.; University of Melbourne, Parkville, VIC, Australia., Pilcher D; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia.; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia., Subramaniam A; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia.; Department of Intensive Care, Dandenong Hospital, Dandenong, VIC, Australia.; Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Sep; Vol. 50 (9), pp. 1496-1505. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1007/s00134-024-07570-w
Abstrakt: Purpose: Perioperative in-hospital cardiac arrests (Perioperative IHCAs) may have better outcomes than IHCAs in the ward (Ward IHCAs), due to enhanced monitoring and faster response. However, quantitative comparisons of their long-term outcomes are lacking, posing challenges for prognostication.
Methods: This retrospective multicentre study included adult intensive care unit (ICU) admissions from theatre/recovery or wards with a diagnosis of cardiac arrest between January 2018 and March 2022. We used data from 175 ICUs in the ANZICS adult patient database. The primary outcome was a survival time of up to 4 years. We used the Cox proportional hazards model adjusted for Sequential Organ Failure Assessment (SOFA) score, age, sex, comorbidities, hospital type, treatment limitation on admission to the ICU, and ICU treatments. Subgroup analyses examined age (≥ 65 years), intubation within the first 24 h, elective vs. emergency admission, and survival on discharge.
Results: Of 702,675 ICU admissions, 5,659 IHCAs were included (Perioperative IHCA 38%; Ward IHCA 62%). Perioperative IHCA group were younger, less frail, and less comorbid. Perioperative IHCA were most frequent in patients admitted to ICU after cardiovascular, gastrointestinal, or trauma surgeries. Perioperative IHCA group had longer 4-year survival (59.9% vs. 33.0%, p < 0.001) than the Ward IHCA group, even after adjustments (adjusted hazard ratio [HR]: 0.63, 95% confidence interval [CI] 0.57-0.69). This was concordant across all subgroups. Of note, older patients with Perioperative IHCA survived longer than both younger and older patients with Ward IHCA.
Conclusion: Patients admitted to the ICU following Perioperative IHCA had longer survival than Ward IHCA. Future studies on IHCA should distinguish these patients.
(© 2024. The Author(s).)
Databáze: MEDLINE
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