Effect And Influencing Factors Retrospective Analysis Of ICU Adult CPR

Background and ObjectiveThere are relatively few studies on CPR of ICU cardiac arrest patients at home and abroad,most of which focus on children,few of which focus on adult patients,with large differences in results.The purpose of this study was to investigate the effect of CPR on ICU cardiac arrest patients and its influencing factors,and to construct a predictive model of CPR patients' death risk,so as to provide a reference for clinical decision-making and rational utilization of resources.MeathodsA retrospective study was conducted on adult patients who were admitted to the comprehensive ICU of zhengzhou people's hospital affiliated to southern medical university and underwent CPR from April 2017 to March 2019.The differences in age,gender,initial heart rhythm,epinephrine dose in ROSC group and Non-ROSC group,survival group and death group were compared,and the influencing factors of CPR effect were screened out through Logistic regression analysis,and the Logistic prediction model was constructed.Results96 patients were included in this study,with a median age of 78 years and a male-female ratio of 1.74:1.27.1%patients recovered ROSC,and 22 survived discharge with or without neurological dysfunction,accounting for 22.9%of the CPR patients.deaths accounted for 77.1%of all CPR patients.There were statistically significant differences between ROSC group and Non-ROSCgroup in age(Z=-2.179,P=0.029),epinephrine dose(Z=-5.138,?2=21.435,P=0.000),CA frequency(?2=4.936,P=0.026)and CPR duration(Z=-5.627,?2=23.941,P=0.000).There were statistically significant differences between the survival and death groups in age(Z=-2.683,P=0.007),epinephrine dose(Z=-5.585,?2=30.109,P=0.000),CA frequency(P=0.012),CPR duration(Z=-5.896,?2=33.970,P=0.000)and APACHE II(?2=4.240,P=0.039).Compared with patients in the Non-ROSC group and the death group,patients in the ROSC group and the survival group were younger,had lower dose of epinephrine,and had shorter CPR duration.patients with epinephrine dose<5mg,occurrence of a single CA,CPR duration<20min had higher ROSC rate and higher discharge survival rate,and patients with APACHE ? score?20 points had higher discharge survival rate.However,There were no statistically significant differences between ROSC group and Non-ROSC group,survival group and death group in gender,CA etiology,initial heart rhythm,ventilation mode,aCCI and GCS(all P>0.05).Univariate Logistic regression analysis showed that the increase of CA frequency(OR=3.176,95%CI=1.112-9.071,P=0.031),large dose of epinephrine(OR=1.596,95%CI=1.302-1.957,P=0.000)and prolonged CPR duration(OR=1.121,95%CI=1.070-1.174,P=0.000)were risk factors that affected ROSC of CPR patients.Univariate Logistic regression analysis revealed age increase(OR=1.028,95%CI=1.000-1.057,P=0.047),the increase of CA frequency(OR=4.431,95%CI=1.505-13.048,P=0.007),large dose of epinephrine(OR=1.761,95%CI=1.399-2.216,P=0.000),APACHE ? score>20(OR=0.358,95%CI=0.132-0.972,P=0.044),prolonged CPR duration(OR=1.151,95%CI=1.089-1.217,P=0.000)were risk factors that affected discharge survival of CPR patients.Multivariate Logistic regression analysis showed that the CPR duration only in ROSC group and Non-ROSC group(OR=1.110,95%CI=1.021-1.208,P=0.015),survival group and death group(OR=1.111,95%CI=1.010-1.223,P=0.031)had significant statistical significance.Prolonged CPR was an independent risk factor for ROSC and survival from discharge.Prediction model of Logistic risk of death for patients with CPR:Ln P/(1-P)=-1.412+ 0.141 x CPR duration(P for predicting the probability of death),The sensitivity and specificity of the model were 89.2%and 68.2%,The positive and negative predictive value were 90.4%and 65.2%Confounding factors did not significantly affect the relationship between CPR duration and prognosis of CPR patients.ConclusionThe majority of ICU adult CPR patients are elderly men,and the ROSC rate and discharge survival rate of the patients are lower and the mortality is higher.Age and APACHE ? only affected the survival of discharge,while CA frequency,epinephrine dose,and CPR duration were the influencing factors for ROSC and survival of discharge,and CPR duration as an independent predictor was positively correlated with patient mortality.The above factors should be highly concerned in clinical practice,and the predictive model can be referred to for clinical decision-making.