ESTIMATION OF SEVERITY OF ILLNESS WITH APACHE-II - AGE-RELATED IMPLICATIONS IN CARDIAC-ARREST OUTCOMES

被引：22

作者：

BEER, RJ ^{[1
]}

TEASDALE, TA ^{[1
]}

GHUSN, HF ^{[1
]}

TAFFET, GE ^{[1
]}

机构：

[1] BAYLOR COLL MED,HUFFINGTON CTR AGING,HOUSTON,TX 77030

来源：

RESUSCITATION | 1994年 / 27卷 / 03期

关键词：

CARDIOPULMONARY RESUSCITATION; SURVIVAL; AGED; IN-HOSPITAL;

D O I：

10.1016/0300-9572(94)90032-9

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

The ability to predict outcomes of cardiac arrest before starting cardiopulmonary resuscitation (CPR) would be useful for discussions of resuscitation with elders and their families. We thought CPR outcome might be dependent on the severity of pre-existing illnesses. The APACHE II is a severity-of-illness (SOI) scale based, in part, on physiologic parameters whereby points are given for degree of deviation from normal. Additionally, up to six points are given for increased age. We hypothesized that (1) patients with the highest APACHE II would be least likely to survive, and (2) because of the blunted physiologic responsiveness, the APACHE II would underestimate the SOI of elderly patients who were sufficiently ill to have a cardiac arrest. A retrospective study of 172 arrests was carried out to evaluate these hypotheses. For the young cohort (n = 126; age, < 70; mean age, 59 +/- 8), mean admission APACHE II was 16.5 +/- 7.9 and pre-arrest APACHE II was 20.8 +/- 8.9. For the old cohort (n = 46; age, greater-than-or-equal-to 70; mean age, 76 +/- 7) admission APACHE II was 17.0 +/- 5.8 (NS) and the pre-arrest APACHE 11 was 20.3 +/- 6.5 (NS). Logistic regression analysis was carried out with both APACHE II scores and factors previously correlated with CPR outcome. Witnessed arrests and those requiring a low number of medications were most likely to result in immediate success (restoration of blood pressure) and in a live discharge. APACHE II score (24 h pre-arrest) was associated with live discharge in the regression analysis. We conclude the pre-arrest APACHE II does add modestly to the ability to predict outcomes of CPR efforts and measures SOI equally well in young and old cohorts.

引用

页码：189 / 195

页数：7

共 22 条

[1]

George, Folk, Crecelius, Campbell, Prearrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest, Am J Med, 87, pp. 28-34, (1989)

[2]

Taffet, Teasdale, Luchi, In-hospital cardiopulmonary resuscitation, J Am Med Assoc, 260, pp. 2069-2072, (1988)

[3]

Bedell, Delbanco, Cook, Epstein, Survival after cardiopulmonary resuscitation in the hospital, N Engl J Med, 309, pp. 569-576, (1983)

[4]

Knaus, Draper, Wagner, Zimmerman, APACHE II: a severity of disease classification system, Crit Care Med, 13, pp. 818-829, (1985)

[5]

Gross, Beyt, Decker, Garibaldi, Hierholzer, Jarvis, Larson, Gimmons, Scheckler, Harkavy, Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA), Infect Control Hosp Epidemiol, 9, pp. 309-316, (1988)

[6]

Thomas, Ashcraft, Zimmerman, An evaluation of alternative severity of illness measures for use by university hospitals, Department of Health Services Management and Policy, vol. 1: Management summary, pp. 1-13, (1986)

[7]

Chang, Jacobs, Lee, Pace, Predicting deaths among intensive care unit patients, Crit Care Med, 16, pp. 34-42, (1988)

[8]

McIntyre, Lewis, Textbook of advanced cardiac life support, (1981)

[9]

Conway, Wheeler, Sannerstedt, Sympathetic nervous activity during exercise in relation to age, Cardiovasc Res, 5, pp. 577-581, (1971)

[10]

Kronenberg, Drage, Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal man, J Clin Invest, 52, pp. 1812-1819, (1973)

← 1 2 3 →