没有证据毯子“Do-Not-Respatiting”Covid-19患者的订单是必要的

It's inappropriate to consider blanket do-not-resuscitate orders for COVID-19 patients because adequate data is not yet available on U.S. survival rates for in-hospital resuscitation of COVID-19 patients and data from China may not relate to U.S. patients, according to a new article published today in循环：心血管质量和结果，美国心脏协会杂志。

提出了Covid-19患者在复苏后的生存率低，基于中国武汉最近的一项研究，其中136名Covid-19患者的整体存活率为2.9％，他们接受了医院内科的心肺复苏逮捕。However, that prognosis should not be applied to the U.S., said Saket Girotra, M.D., S.M., assistant professor of medicine in the division of cardiovascular diseases at the University of Iowa Carver College of Medicine, on behalf of the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) investigators.

在该研究中，“医院内心脏病患者患有危重病人的生存：对Covid-19爆发的影响？”调查人员报告来自医院内心脏逮捕患者的GWTG-R登记处的数据。他们从2014 - 2018年的数据检查了与Covid-19人群相似的患者：5,690名成年患者，在医院治疗心脏逮捕时进行CPR，同时在患有重症监护室（ICU）用于肺炎或败血症，并在心脏骤停时接受机械通风。

虽然研究人员在美国模拟中指出的总生存率仅为12.5％，但有许多可能影响生存和神经系统结果的变量。在关键患者亚组的情况下，生存的概率没有严重的神经功能障碍的范围不到3％至22％以上。在关键患者亚组中，轻度至无残疾的可能性范围为约1％至17％。

而求生存率在初始心律节律不可震动的老年人和病情患者中，年轻患者在较年轻的患者中较低（超过20％），患者在心脏骤停之前没有治疗血管加压剂药物治疗。血管加压剂药物通常用于改善血压和心输出在紧急情况如脓毒性休克或心脏骤停。

"Such large variation in survival rates suggests that a blanket prescription of do-not-resuscitate orders in patients with COVID-19 may be unwarranted. Such a blanket policy also ignores the fact that early experience of the pandemic in the U.S. reveals that a about a quarter of COVID-19 patients are younger than 50 years of age and otherwise healthy. Cardiac arrest in such patients will likely have a different prognosis," the researchers said.

本文得出结论，“......在批判性患者的机械通气患者队列中，内在医院复苏后的存活结果并不均匀差。这些数据可能有助于指导患者，供应商和医院领导人之间的讨论讨论适当使用复苏对于Covid-19患者。“

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