Aim

Isolation of patients in single-patient rooms for infection control precautions leads to less contact with medical staff. Our objective was to assess whether isolated patients who suffer an in-hospital cardiac arrest (IHCA) have lower survival as non-isolated IHCA patients.

Methods

We screened for IHCA occurrence and the isolation state in 75.987 patients that had been hospitalized from 2016 to 2019 at the university hospital. Primary endpoint was survival to discharge. Neurological outcome was assessed using the cerebral performance category scale.

Results

In five consecutive years, 4,249 out of 75,987 patients (5.6%) had to be isolated for infection control precautions. In-hospital cardiac arrest occurred in 32 (0.8%) of these isolated patients and in 410 out of 71,738 non-isolated patients (0.6%) (p = 0.130). Propensity score matching yielded 30 isolated and 30 non-isolated patients who suffered an IHCA, without a difference in baseline characteristics and characteristics of cardiac arrests between the groups. Only one out of 30 isolated patients (3.3%) survived to discharge after IHCA compared to 11 non-isolated patients (36.6%) (risk difference, 33.3% [95% CI, 14.9%–51.7%]. None of the 30 isolated patients were discharged with good neurological outcomes compared to nine out of 30 non-isolated IHCA patients (30%) (risk difference, 30% [95% CI, 13.6%–46.4%]). In the multivariate analysis, patient isolation was an independent predictor of poor survival after IHCA (OR, 18.99; 95% CI, 2.467–133.743).

Conclusions

Isolation of patients for infection control precautions is associated with considerable poorer survival and neurological outcome in case these patients are suffering an IHCA.

中文翻译：

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院内心脏骤停的孤立患者的致命结局

目标

将患者隔离在单人病房以采取感染控制预防措施可减少与医务人员的接触。我们的目标是评估患有院内心脏骤停 (IHCA) 的孤立患者是否比非孤立 IHCA 患者的生存率更低。

方法

我们筛查了 2016 年至 2019 年在大学医院住院的 75.987 名患者的 IHCA 发生情况和隔离状态。主要终点是生存出院。使用脑性能类别量表评估神经系统结果。

结果

连续五年，75,987 名患者中的 4,249 名（5.6%）必须被隔离以采取感染控制预防措施。这些隔离患者中有 32 例（0.8%）和 71,738 例非隔离患者中的 410 例（0.6%）发生了院内心脏骤停（p  = 0.130）。倾向得分匹配产生了 30 名孤立的和 30 名非孤立的 IHCA 患者，两组之间的基线特征和心脏骤停特征没有差异。与 11 名非隔离患者 (36.6%) 相比，30 名隔离患者中只有一名 (3.3%) 在 IHCA 后存活出院（风险差异，33.3% [95% CI，14.9%–51.7%]。30 名隔离患者中没有一人与 30 名非隔离 IHCA 患者中的 9 名 (30%) 相比，患者出院时神经功能良好（风险差异，30% [95% CI，13.6%–46.4%]）。在多变量分析中，患者隔离是一种IHCA 后生存不良的独立预测因子（OR，18.99；95% CI，2.467–133.743）。

结论

如果这些患者患有 IHCA，则隔离患者以采取感染控制预防措施与相当差的存活率和神经系统预后相关。