| Objective Aim to understand the epidemiological data of hospital mortality in the hospital where the study was conducted,to describe the characteristics of in-hospital cardiac arrest(IHCA),to reveal the defects in the process of cardiopulmonary resuscitation and the factors affecting the restoration of spontaneous circulation(ROSC),to analyze the status quo of Do Not Attempt Resuscitation(DNAR),to specify the specific situation of data missing in the rescue record,to provide theoretical basis for the continuous quality improvement strategy of cardiac arrest and resuscitation in hospital.Methods Through the electronic medical record platform,a total of 505 cases of all patients in the hospital died from July 1st,2014 to June 30th,2016.According to Utstein style,the core and auxiliary data and the integrity of the rescue records are collected and evaluated.Summary the data by using Microsoft Excel 2010.According to the chain of survival on classification for a complete recovery,the data were devided to limited resuscitation group,complete resuscitation group,DNAR group.According to the results of the recovery,the data were devided to non-ROSC group,ROSC group,analyzed by SPSS 17.0 statistical.Results(1)From July 1st,2014 to June 30th,2016,505 patients died in the hospital including 31 cases of infants and children(6.1%),474 cases of adult patients(93.9%),and the hospital mortality was 3.1‰.The gender ratio(male:female)of the hospital mortality was 1.90,and the mean age of the hospital mortality of adults was(66.70 + 15.51)years old,and the hospital mortality were mainly in the 50-89 year-old group.Malignant tumors,circulatory system diseases represented by acute myocardial infarction and respiratory diseases represented by pneumonia are the first,second and third causes of hospitalization.The average length of stay was(15.43 + 30.02)days.The morbidity of hypertension,coronary heart disease,diabetes and hyperlipidemia were 40.6%,30.3%,21.8%and 4.6%respectively.The hospital mortality peaks in February,March and July.The time of death of the hospital mortality has no difference in time quantum.The most hospital mortality(18.6%),belongs to the ICU(13.9%),Neurosurgery(7.9%),Department of Hepatological Surgery(4.6%),medical system for Department of Respiratory Medicine(11.3%),Department of Cardiology(9.3%),Department of Neurology(6.1%).(2)Multiple organ dysfunction,severe infection,and non-central circulation failure were the first,second and third causes of IHCA.Among the 113 patients who were able to identify the initial arrhythmia rate,18 cases were ventricular fibrillation and pulse free ventricular tachycardia,accounting for 15.9%(3)The ROSC rate was 21.9%in the patients who had experienced the recovery,and the complete recovery group ROSC rate was 31.0%,and the ROSC rate of the limited recovery group was 9.3%.The second classification Logistic analysis showed that the full recovery and IHCA occurred in the ICU was a favorable factor for ROSC.(4)Among the patients undergoing resuscitation,2 cases(0.6%)were absent of external chest compression.54 cases(19.2%)were absent of the advanced airway support.2 cases(11.8%)were absent of defibrillation.1 case(0.3%)were absent of resuscitation drugs.43 cases with advanced airway support DNAR intention were absent of balloon-mask artificial respiration(21.7%).Coma-advanced airway support interval was(12.27+9.52)min.(5)During the resuscitation,the proportion of patients who applied the epinephrine,isoprenaline and atropine;applied the nikethamide and lobeline and applied all the drugs above was 50.5%,43.2%and 28.1%.The dosage of average unit time of epinephrine was lower than the recommended range,and the average amount of isoproterenol,atropine,nikothamide,and lobeline was extremely high.(6)There are 145 patients(28.7%)refused to attempt any resuscitation,among which 3 cases were infants and children,accounting for 9.7%of all infants and children,142 cases were adults,accounting for 30.0%of all adult patients.The proportion of patients who refused chest compressions was 38.0%;The proportion of patients who refused endotracheal intubation was 44.4%;The percentage of patients who refused to apply resuscitation drugs was 28.7%;Only one patient declined defibrillation.(7)In rescuing records,loss of the time of IHC A,the time of hospital and the IHCA scene mortality were rarely,5.3%continued recovery time is missing,lack of the first witness and initial heart rhythm were 73.7%,77.6%,faint-chest compressions interphase,faint-advanced airway support interphase,faint-first defibrillation interphase,faint-the first time drug useage interphase missing were 95.2%,42.2%,32.6%,42.2%respectively,the resuscitation drug dosage usage,lack of recovery medicine dosing time were 32.3%,40.9%respectively.Conclusion(1)Cardiac arrest in the hospital happens more common in men,often associated with chronic diseases,and 28.7%of patients refuse to attempt any resuscitation.(2)The research in the hospital after the recovery of patients with hospital mortality ROSC rate is lower than the report at domestic and overseas,with chain of survival missing links in the process of resuscitation,resuscitation drug use undeserved,complete recovery,IHCA in ICU is ROSC favorable factors.(3)There is a pervasive lack of part of data in the rescue records of the hospital. |
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