Aim

We aimed to investigate whether trained intensivist coverage affects survival outcomes following in-hospital cardiopulmonary resuscitation (ICPR) for in-hospital cardiac arrest (IHCA).

Methods

All adult patients who received ICPR for IHCA between January 1, 2016 and December 31, 2019 in South Korea were included. Patients who received ICPR in hospitals with trained intensivist coverage for ICU staffing were defined as the intensivist group, whereas other patients were considered the non-intensivist group.

Results

In total 68,286 adult patients (36,025 [52.8%] in the intensivist group and 32,261 [47.2%] in the non-intensivist group) were included in the analysis. After propensity score (PS) matching 40,988 patients (20,494 in each group) were included. In logistic regression after PS matching, the intensivist group showed a 17% (odds ratio: 1.17; 95% confidence interval [CI]: 1.12–1.22; P < 0.001) higher live discharge rate after ICPR than the non-intensivist group. In Cox regression after PS matching, the 6-month and the 1-year mortality rates in the intensivist group after ICPR were 11% (hazard ratio [HR]: 0.89; 95% CI: 0.87–0.91; P < 0.001) and 10% (HR: 0.90; 95% CI: 0.88–0.92; P < 0.001) lower than those in the non-intensivist group, respectively. In Kaplan–Meir estimation the median survival time after ICPR in the intensivist group was 12.0 days (95% CI: 11.6–12.4) while that in the non-intensivist group was 8.0 days (95% CI: 7.7–8.3).

Conclusions

Trained intensivist coverage in the ICU was associated with improvements in both short and long-term survival outcomes after ICPR for IHCA.

中文翻译：

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训练有素的重症监护覆盖率对院内心肺复苏后生存结果的影响：在韩国进行的一项全国性队列研究

目标

我们旨在调查训练有素的重症监护覆盖率是否会影响院内心脏骤停 (IHCA) 的院内心肺复苏 (ICPR) 后的生存结果。

方法

纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间在韩国接受 IHCA ICPR 的所有成年患者。在医院接受 ICPR 且接受过 ICU 人员配备训练的重症监护医师的患者被定义为重症监护组，而其他患者则被视为非重症监护组。

结果

共有 68,286 名成年患者（重症监护组 36,025 [52.8%] 和非重症监护组 32,261 [47.2%]）被纳入分析。倾向评分 (PS) 匹配后，共纳入 40,988 名患者（每组 20,494 名）。在 PS 匹配后的逻辑回归中，重症监护组 在 ICPR 后的活出院率比非重症监护组高17%（优势比：1.17；95% 置信区间 [CI]：1.12–1.22； P < 0.001）。在 PS 匹配后的 Cox 回归中，ICPR 后重症监护组的 6 个月和 1 年死亡率分别为 11%（风险比 [HR]：0.89；95% CI：0.87–0.91；P  < 0.001）和 10 %（HR：0.90；95% CI：0.88–0.92；P < 0.001) 分别低于非重症监护组。在 Kaplan-Meir 估计中，重症监护组 ICPR 后的中位生存时间为 12.0 天（95% CI：11.6-12.4），而非重症监护组为 8.0 天（95% CI：7.7-8.3）。

结论

ICU 中训练有素的重症监护覆盖率与 IHCA 的 ICPR 后短期和长期生存结果的改善有关。