Resuscitation最新文献

Importance: The association between frailty and long-term outcomes following intensive care unit (ICU) admission after a medical emergency team (MET) review is poorly understood.

Objective: To evaluate whether frailty was associated with increased one-year mortality among ICU patients admitted after a ward MET review.

Design: Retrospective registry-based cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database.

Setting and participants: Adult patients (≥16 years) admitted to 184 ICUs between 1 January 2018 and 30 June 2022 with a documented Clinical Frailty Scale (CFS) score were included.

Interventions: None.

Measurements and main results: Frailty was assessed categorically using the CFS 1-8. The primary outcome was one-year mortality, ascertained via linkage with respective national death registries. Associations between frailty and one-year mortality were evaluated using multivariable hierarchical logistic regression. A total of 48,425 patients were included. Patients with higher frailty scores were older, more likely to have treatment limitations and a greater chronic disease burden. The adjusted probability of one-year mortality increased progressively from 12.3% for CFS-1 to 60.8% for CFS-8. Compared with CFS-1, increased risk was observed beyond CFS-3, with the adjusted attributable mortality risk ranging from +5.6% (95%CI: 2.8-8.4%) for CFS-2 to +48.5% (95%CI: 43.6-53.4%) for CFS-8.

Conclusions: In this large cohort of ICU patients admitted after a MET review, frailty was independently associated with higher one-year mortality, with outcomes worsening progressively with incrementing CFS. Our findings highlight the importance of incorporating frailty assessment into MET and ICU decision-making to guide individualised, goal-concordant care.

Background: Foreign body airway obstruction (FBAO) is a time-sensitive, preventable cause of hypoxic brain injury and death, yet the quantitative time-outcome relationship remains poorly quantified in prospective cohorts. We evaluated the association between airway obstruction time and outcomes in patients with FBAO to evaluate whether any clinical "safe" time window exists.

Methods: We conducted a secondary analysis of the nationwide, prospective MOCHI registry in Japan. To minimize the influence of outliers, the primary analysis was restricted to patients with airway obstruction times of 0-25 min. The primary outcome was 30-day survival; the secondary outcome was 30-day favorable neurological outcome, defined as Cerebral Performance Category 1-3. Odds ratios (ORs) per 1-min increase were estimated using multivariable logistic regression and spline models.

Results: Of 409 patients, 229 met the primary inclusion criteria. Median age was 81 years and 48% were male; 60% survived to 30 days and 47% had favorable neurological outcome. Longer obstruction duration was independently associated with lower odds of survival (adjusted OR [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and favorable neurological outcome (aOR 0.85; 95% CI 0.80-0.89). Spline models showed a steep monotonic decline in predicted outcomes immediately from onset without evidence of a distinct threshold or "safe" time window.

Conclusions: Outcomes declined continuously per minute of unresolved obstruction, with no inflection point or "safe" time window. This highlights that every minute of delay worsens prognosis, reinforcing the need for immediate bystander intervention.