Pediatric Emergency Care Applied Research Network, Salt Lake City, UT, USA.
Crit Care Med. 2011 Jan;39(1):141-9. doi: 10.1097/CCM.0b013e3181fa3c17.
To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest.
A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible.
One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases.
Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
描述一组循环恢复的院外心脏骤停儿童，并确定与生存相关的早期复苏期因素。这些目标是为儿科心脏骤停后治疗性低温治疗的干预试验做计划。
在 18 个月的研究期间，在 15 个儿科急救护理应用研究网络临床站点进行了回顾性队列研究。所有年龄在 1 天（24 小时）至 18 岁之间、有至少 1 分钟的胸外按压史且至少 20 分钟恢复循环的院外心脏骤停患儿均符合研究入选标准。
138 例符合研究入选标准；总的死亡率为 62%（85/138 例）。与生存增加相关的事件特征如下：周末发病、复苏未在到达医院时进行、无心动过速或室颤/室速、无阿托品或碳酸氢钠、肾上腺素剂量较少、心肺复苏持续时间较短、溺水或窒息性骤停。对于复苏后 0 至 12 小时的再循环期，没有使用任何血管加压药或正性肌力药（多巴胺、肾上腺素）、记录的最低温度较高、最低 pH 值较低、乳酸较低、最大葡萄糖较低以及正常瞳孔反应均与生存相关。在发病时可用变量的多变量逻辑模型中，控制性别、年龄、种族以及在发病期间任何时候的心动过缓或室颤/室速，发现使用阿托品和肾上腺素与死亡率相关。使用再循环后 12 小时内可用的其他信息的第二个模型发现 1）存在肺部或气道疾病；2）发病原因为溺水或窒息；3）较高的 pH 值，以及 4）双侧反应性瞳孔与较低的死亡率相关。在 96%（44/46）的病例中，接受超过 3 剂肾上腺素与不良预后相关。
确定了多个与循环恢复的院外儿科心脏骤停后生存相关的因素。再循环后数小时内获得的额外信息可能会降低回归模型中早期获得的因素与结果的关联。在设计旨在改善儿科心脏骤停后结局的未来干预试验时，应考虑这些因素。
