Intensive Care Unit, Westmead Hospital, Westmead, NSW 2145, Australia.
Resuscitation. 2012 Jun;83(6):699-704. doi: 10.1016/j.resuscitation.2011.12.004. Epub 2011 Dec 14.
The role of immediate coronary angiography and percutaneous coronary intervention (angio±PCI), amongst comatose survivors of out-of-hospital cardiac arrest is unclear. This study was undertaken to evaluate if immediate angio±PCI compared to no initial intervention improves neurological outcome at hospital discharge amongst comatose survivors of out-of-hospital pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF).
All patients admitted to Intensive Care Unit (ICU) following an out-of-hospital VF/pVT arrest from 1/1/2003 to 31/12/2008 were included. Outcome of patients who underwent immediate angio±PCI was compared to those who did not undergo any intervention before admission to ICU. Good outcome was defined as survival to hospital discharge with Cerebral Performance Category (CPC) score of 1 or 2.
Thirty-five patients (30 Males, 5 Females, mean age 60.3±10.1), underwent angio±PCI prior to ICU admission. A further 35 patients (20 Males, 15 Females, mean age 61.1±17.6 years) were admitted directly to ICU without undergoing any intervention. Forty percent (14/35) of patients who had immediate coronary intervention survived to hospital discharge with a good outcome compared to 31% (11/35) patients who did not undergo any intervention. After adjusting for other covariates, the probability of good outcome at hospital discharge was related to severity of illness (SAPS-II) score at ICU admission (adj OR=0.87, 95% CI 0.81-0.94, p<0.01). Immediate angio±PCI compared to no intervention was associated with an improved outcome but this difference was statistically not significant (adj OR 1.32, 95% CI 0.26-7.87, p=0.78).
Immediate angio±PCI in comatose survivors of out-of-hospital VF/pVT arrest did not lead to better neurological outcome at hospital discharge.
对于院外心搏骤停昏迷幸存者，立即进行冠状动脉造影和经皮冠状动脉介入治疗（血管造影+PCI）的作用尚不清楚。本研究旨在评估与无初始干预相比，在院外无脉性室性心动过速（pVT）或心室颤动（VF）后昏迷的幸存者中，立即进行血管造影+PCI 是否能改善出院时的神经功能结局。
纳入了 2003 年 1 月 1 日至 2008 年 12 月 31 日期间因 VF/pVT 院外心脏骤停后入住重症监护病房（ICU）的所有患者。比较了立即进行血管造影+PCI 的患者的结局与未在入住 ICU 前进行任何干预的患者的结局。良好结局定义为存活至出院，且神经功能预后量表（CPC）评分为 1 或 2 分。
35 例患者（30 例男性，5 例女性，平均年龄 60.3±10.1 岁）在入住 ICU 前进行了血管造影+PCI。另外 35 例患者（20 例男性，15 例女性，平均年龄 61.1±17.6 岁）直接入住 ICU 而未进行任何干预。在接受立即冠状动脉干预的患者中，有 40%（14/35）存活至出院且预后良好，而未接受任何干预的患者中，这一比例为 31%（11/35）。在调整其他协变量后，出院时的良好预后与 ICU 入院时的疾病严重程度评分（SAPS-II）相关（调整后的比值比=0.87，95%置信区间 0.81-0.94，p<0.01）。与无干预相比，立即进行血管造影+PCI 与改善的结局相关，但差异无统计学意义（调整后的比值比 1.32，95%置信区间 0.26-7.87，p=0.78）。
在院外 VF/pVT 心脏骤停昏迷幸存者中，立即进行血管造影+PCI 并不能改善出院时的神经功能结局。
