Ruygrok Michael L, Byyny Richard L, Haukoos Jason S
University of Colorado Denver School of Medicine, Aurora, CO, USA.
Ann Emerg Med. 2009 Aug;54(2):239-47. doi: 10.1016/j.annemergmed.2008.11.012. Epub 2009 Jan 21.
Several termination of resuscitation criteria have been proposed to identify patients who will not survive to hospital discharge after out-of-hospital cardiac arrest. However, only 1 set has been derived to specifically predict survival to hospital discharge with good neurologic function. The objectives of this study were to externally validate the basic life support (BLS) termination of resuscitation, advanced life support (ALS) termination of resuscitation, and neurologic termination of resuscitation criteria and compare their abilities to predict survival to hospital discharge with good neurologic function after out-of-hospital cardiac arrest.
This was a secondary analysis of the Denver Cardiac Arrest Registry. Consecutive adult nontraumatic cardiac arrest patients in Denver County from January 1, 2003, through December 31, 2004, were included in the study. The BLS termination of resuscitation, ALS termination of resuscitation, and neurologic termination of resuscitation criteria were applied to the cohort, and their predictive proportions and 95% confidence intervals (CIs) were calculated for each set of criteria.
Of the 715 patients included in this study, the median age was 65 years (interquartile range 52 to 78 years), and 69% were male patients. In addition, 223 (31%) had return of spontaneous circulation, 175 (24%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%) survived to hospital discharge with good neurologic function. The proportion of patients with good neurologic survival to hospital discharge correctly identified for continued resuscitation was 100% (95% CI 92% to 100%) for all 3 termination of resuscitation criteria. The proportion of patients with poor neurologic survival to hospital discharge or no survival to hospital discharge correctly identified as eligible for termination of resuscitation was 36% (95% CI 32% to 40%) with the BLS termination of resuscitation criteria, 25% (95% CI 22% to 29%) with the ALS termination of resuscitation criteria, and 6% (95% CI 4% to 8%) with the neurologic termination of resuscitation criteria. Use of the BLS termination of resuscitation criteria would have reduced transport of the largest number of patients.
All 3 termination of resuscitation criteria had equally high abilities to identify patients requiring continued resuscitation. The BLS termination of resuscitation criteria, however, had the best combined ability to predict good neurologic survival and poor neurologic survival or death. These findings and the relative simplicity of the BLS termination of resuscitation criteria support their use.
已提出多种复苏终止标准，以识别院外心脏骤停后无法存活至出院的患者。然而，仅有一组标准专门用于预测存活至出院且神经功能良好的情况。本研究的目的是对外验证基本生命支持（BLS）复苏终止标准、高级生命支持（ALS）复苏终止标准和神经学复苏终止标准，并比较它们预测院外心脏骤停后存活至出院且神经功能良好的能力。
这是对丹佛心脏骤停登记处的二次分析。纳入了2003年1月1日至2004年12月31日丹佛县连续的成年非创伤性心脏骤停患者。将BLS复苏终止标准、ALS复苏终止标准和神经学复苏终止标准应用于该队列，并计算每组标准的预测比例及95%置信区间（CI）。
本研究纳入的715例患者中，中位年龄为65岁（四分位间距52至78岁），男性患者占69%。此外，223例（31%）恢复自主循环，175例（24%）存活至入院，58例（8%）存活至出院，42例（6%）存活至出院且神经功能良好。对于所有3种复苏终止标准，正确识别为需继续复苏且存活至出院且神经功能良好的患者比例为100%（95%CI 92%至100%）。BLS复苏终止标准正确识别为符合复苏终止条件的存活至出院且神经功能差或未存活至出院的患者比例为36%（95%CI 32%至40%），ALS复苏终止标准为25%（95%CI 22%至29%），神经学复苏终止标准为6%（95%CI 4%至8%）。使用BLS复苏终止标准可减少最多数量患者的转运。
所有3种复苏终止标准在识别需要继续复苏的患者方面能力相当。然而，BLS复苏终止标准在预测存活至出院且神经功能良好以及存活至出院且神经功能差或死亡方面具有最佳综合能力。这些发现以及BLS复苏终止标准相对简单的特点支持其应用。
