RESUMO
Objective:To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies.Methods:The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death.Results:177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC ( n = 104), sudden death in non-ROSC patients ( n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically ( n = 91) showed similar characteristics compared with patients who recovered consciousness ( n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio ( OR) = 8.06, 95% confidence interval (95% CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95% CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95% CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95% CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. Conclusions:Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.
RESUMO
Objective:To provide the basis and direction for the establishment of the database of severe patients by analyizing of the disease composition and outcome of patients in the department of critical care medicine of the 3A hospital.Methods:The clinical data of 3 249 patients admitted to the department of critical care medicine of Liaocheng People's Hospital from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including gender, age, admission time, admission route, diagnosis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 24 hours after admission, outcome and other information.Results:The mean age of 3 249 patients was (61.99±18.29) years old, and the proportion of young and old patients aged 60-74 years accounted the largest (34.01%). There were more males (1 800 cases) than females (1 449 cases). The most patients were admitted in January (119 cases) and the least in March (75 cases). The top eight diseases in the department of critical care medicine were respiratory system diseases (21.88%), multiple injuries (12.65%), cardiovascular system diseases (11.48%), gastrointestinal surgery diseases (9.42%), pathological obstetrics (7.76%), digestive system diseases (7.63%), urinary system diseases (5.69%) and nervous system diseases (5.23%). Among 3 249 critically ill patients, 54.36% (1 766 cases) were transferred to the general ward for treatment after improvement, with APACHE Ⅱ score was 17.99±5.51. 15.91% (517 cases) returned to local hospital for further treatment after improvement, APACHE Ⅱ score was 22.48±6.57. 1.51% (49 cases) were transferred to superior hospitals, APACHE Ⅱ score was 21.71±5.18. 24.22% (787 cases) were discharged automatically, APACHE Ⅱ score was 25.64±5.45. 4.00% (130 cases) died in intensive care unit (ICU), APACHE Ⅱ score was 29.08±8.10. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the differences were statistically significant (all P < 0.001). Among 3 249 patients, a total of 1 265 patients were admitted to ICU for sepsis caused by aggravated infection, and 44.43% (562 cases) of the 1 265 patients improved to the general ward after treatment, with APACHE Ⅱ score was 18.99±5.46. 19.21% (243 cases) returned to local hospital after treatment with APACHE Ⅱ score was 22.79±6.74. 1.50% (19 cases) were transferred to superior hospitals for further treatment with APACHE Ⅱ score was 21.21±4.81. 31.54% (399 cases) were discharged automatically with APACHE Ⅱ score was 25.55±4.84; 3.32% (42 cases) died in ICU with APACHE Ⅱ score was 27.69±7.92. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the difference was statistically significant (all P < 0.001). Conclusions:Among the patient admitted to ICU 2019-2021 in Liaocheng People's Hospital, respiratory system diseases accounted for the first, multiple injuries accounted for the second place, followed by cardiovascular system diseases, gastrointestinal surgery diseases, pathological obstetrics, etc. Males and elderly patients aged 60-74 years have a higher proportion of severe cases. APACHE Ⅱ scores were associated with patients' prognosis.