Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Resuscitation. 2012 Dec;83(12):1451-5. doi: 10.1016/j.resuscitation.2012.05.008. Epub 2012 May 24.
This study investigated the incidence of hyperfibrinolysis upon emergency department (ED) admission in patients with out of hospital cardiac arrest (OHCA), and the association of the degree of hyperfibrinolysis with markers of hypoperfusion.
From 30 OHCA patients, cardiopulmonary resuscitation (CPR) time, pH, base excess (BE), and serum lactate were measured upon ED admission. A 20% decrease of rotational thromboelastometry maximum clot firmness (MCF) was defined as hyperfibrinolysis. Lysis parameters included maximum lysis (ML), lysis onset time (LOT) and lysis index at 30 and 45 min (LI30/LI45). The study was approved by the Human Subjects Committee.
Hyperfibrinolysis was present in 53% of patients. Patients with hyperfibrinolysis had longer median CPR times (36 (15-55) vs. 10 (7-18)min; P=0.001), a prolonged activated partial thromboplastin time (54 ± 16 vs. 38 ± 10s; P=0.006) and elevated D-dimers (6.1 ± 2.1 vs. 2.3 ± 2.0 μg/ml; P=0.02) when compared to patients without hyperfibrinolysis. Hypoperfusion markers, including pH (6.96 ± 0.11 vs. 7.17 ± 0.15; P<0.001), base excess (-20.01 ± 3.53 vs. -11.91 ± 6.44; P<0.001) and lactate (13.1 ± 3.7 vs. 8.0 ± 3.7 mmol/l) were more disturbed in patients with hyperfibrinolysis than in non-hyperfibrinolytic subjects, respectively. The LOT showed a good association with CPR time (r=-0.76; P=0.003) and lactate (r=-0.68; P=0.01), and was longer in survivors (3222 ± 34s) than in non-survivors (1,356 ± 833; P=0.044).
A substantial part of OHCA patients develop hyperfibrinolysis in association with markers for hypoperfusion. Our data further suggest that the time to the onset of clot lysis may be an important marker for the severity of hyperfibrinolysis and patient outcome.
本研究旨在调查院外心脏骤停（OHCA）患者急诊就诊时是否存在高纤溶，并探讨高纤溶的程度与低灌注标志物之间的相关性。
对 30 例 OHCA 患者，测量其急诊就诊时心肺复苏（CPR）时间、pH 值、碱剩余（BE）和血清乳酸水平。当旋转血栓弹性描记术（ROTEM）最大凝块硬度（MCF）降低 20%时定义为高纤溶。纤溶参数包括最大纤溶（ML）、纤溶起始时间（LOT）以及 30 分钟和 45 分钟时的纤溶指数（LI30/LI45）。本研究获得了人体研究委员会的批准。
53%的患者存在高纤溶。与无高纤溶的患者相比，高纤溶组患者 CPR 时间中位数更长[36（15-55）分钟 vs. 10（7-18）分钟；P=0.001]，活化部分凝血活酶时间（APTT）更长[54±16 秒 vs. 38±10 秒；P=0.006]，D-二聚体水平更高[6.1±2.1μg/ml vs. 2.3±2.0μg/ml；P=0.02]。与无高纤溶的患者相比，低灌注标志物 pH 值[6.96±0.11 比 7.17±0.15；P<0.001]、碱剩余（BE）值[-20.01±3.53 比-11.91±6.44；P<0.001]和乳酸值[13.1±3.7 比 8.0±3.7mmol/L]在高纤溶组中更差。LOT 与 CPR 时间（r=-0.76；P=0.003）和乳酸（r=-0.68；P=0.01）均有良好的相关性，在幸存者（3222±34 秒）中明显长于非幸存者（1356±833 秒；P=0.044）。
相当一部分 OHCA 患者发生高纤溶，与低灌注标志物相关。我们的数据进一步表明，凝血块开始溶解的时间可能是高纤溶程度和患者预后的重要标志物。
