Eich Christoph, Bräuer Anselm, Timmermann Arnd, Schwarz Stephan K W, Russo Sebastian G, Neubert Karin, Graf Bernhard M, Aleksic Ivan
Department of Anaesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Göttingen, Germany.
Resuscitation. 2007 Oct;75(1):42-52. doi: 10.1016/j.resuscitation.2007.03.013. Epub 2007 May 11.
In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the "Utstein Style for Drowning" (USFD) to advance knowledge on the epidemiology, treatment, and outcome prediction after drowning. Applying the USFD and evaluating its data template for outcome analysis, we report here on the largest study published thus far of drowned children (age 0-14) who underwent attempted resuscitation on cardiopulmonary bypass (CPB).
We conducted a retrospective review of all drowned children admitted to Göttingen University Hospital between 1/1987 and 12/2005 in sustained cardiopulmonary arrest and resuscitation with CPB. We correlated eight outcome-affecting USFD variables and four additional variables not included in the USFD with potential impact on outcome to four outcome groups: survival, non-survival, survival with full recovery, and failed resuscitation.
Out of 12 children (aged 22 months to 7.5 years), 5 survived to hospital discharge and 7 died in hospital. Two survivors recovered fully and three remained in a vegetative state. In two patients, resuscitation on CPB failed. Both children who fully recovered, compared to the 10 others, had relatively low serum K+ concentrations (2.6 and 3.7 mmol/l versus 5.8+/-3.8 mmol/l [mean+/-S.D.; n=10]), a relatively slow rewarming speed (1.9 and 1.2 degrees C/h versus 3.4+/-1.8 degrees C/h), were female (all three girls survived), received early basic life support (BLS) and showed idioventricular bradycardia. Both children with failed resuscitation had severe hyperkalaemia (11.7 and 13.3 mmol/l versus 10 others, 4.0+/-1.5 mmol/l), were relatively rapidly rewarmed (6.9 and 4.0 degrees C/h versus 10 others, 2.61+/-1.32 degrees C/h), male, and in asystole. We identified no outcome trends for age, pH, or water and core temperatures.
Most variables relevant for outcome in drowned children can be documented with the use of the USFD. Additional variables not included in the USFD that have emerged from this study and may predict outcome include serum K+ concentration, rewarming speed, and initial cardiac rhythm.
2003年，国际复苏联合委员会（ILCOR）发布了《溺水的Utstein风格》（USFD），以增进对溺水后的流行病学、治疗及预后预测的了解。应用USFD并评估其用于结果分析的数据模板，我们在此报告迄今为止发表的关于接受体外循环（CPB）心肺复苏的溺水儿童（0 - 14岁）的最大规模研究。
我们对1987年1月至2005年12月期间入住哥廷根大学医院且在持续心肺骤停后接受CPB复苏的所有溺水儿童进行了回顾性研究。我们将八个影响预后的USFD变量以及四个未包含在USFD中但可能对预后有影响的额外变量与四个预后组相关联：存活、未存活、完全康复存活以及复苏失败。
在12名儿童（年龄22个月至7.5岁）中，5名存活至出院，7名在医院死亡。两名幸存者完全康复，三名仍处于植物人状态。两名患者CPB复苏失败。与其他10名儿童相比，两名完全康复的儿童血清钾浓度相对较低（分别为2.6和3.7 mmol/L，而其他10名儿童为5.8±3.8 mmol/L [均值±标准差；n = 10]），复温速度相对较慢（分别为1.9和1.2℃/小时，而其他10名儿童为3.4±1.8℃/小时），为女性（三名女孩均存活），接受了早期基础生命支持（BLS）且表现为心室自主心律过缓。两名复苏失败的儿童均有严重高钾血症（分别为11.7和13.3 mmol/L，而其他10名儿童为4.0±1.5 mmol/L），复温相对较快（分别为6.9和4.0℃/小时，而其他10名儿童为2.61±1.32℃/小时），为男性，且处于心搏停止状态。我们未发现年龄、pH值、水温及核心温度的预后趋势。
使用USFD可以记录与溺水儿童预后相关的大多数变量。本研究中出现的未包含在USFD中但可能预测预后的额外变量包括血清钾浓度、复温速度及初始心律。
