Associação do período de ocorrência da parada cardiorrespiratória intra-hospitalar com o retorno à circulação espontânea e com o óbito
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Data
2022-12-22
Autores
Favero Junior, Edson Luiz [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Em hospitais de todo mundo, a implantação de Times de Resposta Rápida (TRR) garante melhora de assistência para pacientes internados que evoluem com deterioração clínica. Os pacientes internados em hospitais que não contam com essas equipes apresentam piores resultados de reanimação nos períodos noturnos e nos finais de semana. Objetivo: Avaliar a taxa de retorno à circulação espontânea e o óbito intra-hospitalar em pacientes com parada cardiorrespiratória intra-hospitalar (PCRIH) quando comparados períodos noturnos com diurnos e finais de semana com dias de semana atendidas por um Time de Resposta Rápida. Pacientes e Métodos: Trata-se de estudo de coorte retrospectiva que incluiu todos os pacientes com PCRIH que ocorreram no período de março de 2018 a dezembro de 2021. Os dados referentes ao período de ocorrência da parada cardiorrespiratória (PCR) foram registrados, bem como se houve retorno à circulação espontânea (RCE) e óbito intra-hospitalar. Realizamos regressões logísticas uni e multivariadas ajustadas pelas variáveis com diferença estatística nas análises univariadas e com base na literatura. O nível de significância adotado foi de 5%. Resultados: Incluímos 387 pacientes neste estudo. A média de idade foi de 65,4 ±14,8, 53,7% eram homens, 91,2% evoluíram com ritmos não chocáveis, 50,6% dos eventos aconteceram durante o dia e 70,8% apresentaram PCR de segunda a sexta-feira. Entre os desfechos avaliados, a taxa de RCE foi de 42,9% e a mortalidade hospitalar foi de 94,3%. Na regressão logística múltipla, não houve diferença estatística quando comparamos o RCE dia versus noite (OR = 1,231; IC 0,823-1,843; p = 0,312), quando ajustado por sexo, idade, ritmo e tempo de PCR (OR = 1,111; IC 0,681-1,811; p = 0,674) e ajustado para idade, ritmo e tempo de PCR (OR = 1,111; 0,681-1,811; p = 0,674). No entanto, houve diferença estatística quando comparamos os resultados de RCE ocorridos durante a semana e finais de semana (OR = 1,566; IC = 0,999-2,455; p = 0,05), quando ajustado por sexo, idade, ritmo e tempo de PCR. Conclusões: Não há diferença quando comparamos os eventos de PCRIH assistidos pelo TRR dia versus noite. No entanto, há diferença significativa quando comparamos eventos ocorridos durante a semana versus final de semana em relação ao RCE, mas não em relação ao óbito hospitalar.
Introduction: In hospitals around the world, the implementation of Rapid Response Teams ensures improved care for inpatients who evolve with clinical deterioration. Those patients admitted to hospitals that do not have these team have worse resuscitation results at night and on weekends. Objective: To evaluate the return of spontaneous ciruculation (ROSC) rate and intra-hospitalar mortality in patients with intra-hospital cardiac arrest (IHCA) when compared night periods with day periods and weekends with week days attended by a Rapid Response Team. Material and methods: We conduct a cohort study that included all patients with IHCA occurred between March 2018 and December 2021. The data referred to the period where recorded, as well if the patient had a ROSC and intra hospital mortality. We did uni and multivariated logistical regretions adjusted by variables with statistical difference on univariated analysis and embased on literature. The significance level adopted were 5%. Results: We included 387 patients in our study. The mean age was 65,4 ±14,8. 53,7% were men. 91,2 evoluted with non-shockable rhythms. 50,6% of the events occurred during the day and 70,8% presented cardiac arrest (CA) on week days. Beside the outcome evaluated, the ROSC rate was 42,9% and the intra-hospitalar mortality was 94,3%. On the multi variation regretion logistic analysis, there was no statistical difference when compared ROSC on day period versus night period (OR = 1,231; IC 0,823-1,843; p = 0,312), when adjusted by gender, age and time of CA (OR = 1,111; IC 0,681-1,811; p = 0,674). Nevertheless, there was no difference when compared the results of ROSC rate between week days and weekends (OR = 1,566; IC = 0,999-2,455; p = 0,05), when adjusted bay gender, rhythm and time of CA. Conclusion: There was no difference when compared IHCA assisted by RRT comparing day turns with night turns. However, there was a statically significance when compared events occurred during week days versus occurring during weekends related to ROSC, but not related to intra hospital mortality.
Introduction: In hospitals around the world, the implementation of Rapid Response Teams ensures improved care for inpatients who evolve with clinical deterioration. Those patients admitted to hospitals that do not have these team have worse resuscitation results at night and on weekends. Objective: To evaluate the return of spontaneous ciruculation (ROSC) rate and intra-hospitalar mortality in patients with intra-hospital cardiac arrest (IHCA) when compared night periods with day periods and weekends with week days attended by a Rapid Response Team. Material and methods: We conduct a cohort study that included all patients with IHCA occurred between March 2018 and December 2021. The data referred to the period where recorded, as well if the patient had a ROSC and intra hospital mortality. We did uni and multivariated logistical regretions adjusted by variables with statistical difference on univariated analysis and embased on literature. The significance level adopted were 5%. Results: We included 387 patients in our study. The mean age was 65,4 ±14,8. 53,7% were men. 91,2 evoluted with non-shockable rhythms. 50,6% of the events occurred during the day and 70,8% presented cardiac arrest (CA) on week days. Beside the outcome evaluated, the ROSC rate was 42,9% and the intra-hospitalar mortality was 94,3%. On the multi variation regretion logistic analysis, there was no statistical difference when compared ROSC on day period versus night period (OR = 1,231; IC 0,823-1,843; p = 0,312), when adjusted by gender, age and time of CA (OR = 1,111; IC 0,681-1,811; p = 0,674). Nevertheless, there was no difference when compared the results of ROSC rate between week days and weekends (OR = 1,566; IC = 0,999-2,455; p = 0,05), when adjusted bay gender, rhythm and time of CA. Conclusion: There was no difference when compared IHCA assisted by RRT comparing day turns with night turns. However, there was a statically significance when compared events occurred during week days versus occurring during weekends related to ROSC, but not related to intra hospital mortality.
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Palavras-chave
Retorno à circulação espontânea, Mortalidade, Parada cardíaca, Equipe de respostas ràpidas de hospitais.