Miyata Kei, Mikami Takeshi, Asai Yasufumi, Iihoshi Satoshi, Mikuni Nobuhiro, Narimatsu Eichi
Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan; Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan.
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):446-52. doi: 10.1016/j.jstrokecerebrovasdis.2013.03.024. Epub 2013 May 13.
This study was undertaken to retrospectively investigate clinical features of subarachnoid hemorrhage (SAH) with cardiopulmonary arrest in patients achieving return of spontaneous circulation (ROSC) in order to explore the possibility of long-term survival.
Of 143 SAH patients with cardiopulmonary arrest in our hospital between April 2004 and June 2012, data on 59 (41%) patients who attained ROSC were analyzed to determine the predictive factors for neurologic recovery and outcome. Recovery of brainstem reflexes and improvement of Glasgow Coma Scale (GCS) motor score were noted (postresuscitation neurologic restorative assessment, grade I) in 5, and 2 of these patients survived.
By-grade analysis of patient background characteristics revealed a significantly shorter duration of cardiac arrest (P = .001) and a significantly smaller adrenaline dose (P = .011) for grade I patients. A logistic analysis of 1-week survival data revealed significant differences in duration of cardiac arrest (P = .022) and adrenaline dose (P = .019), with odds ratios of 0.89 and 0.25, respectively. Cox regression analysis of mortality data revealed significant differences in the duration of cardiac arrest (P = .012), adrenaline dose (P < .0001), and location of ROSC (P = .016), with hazard ratios of 1.03, 1.43, and 1.98, respectively.
Cardiac arrest caused by SAH is a disease state with a grave prognosis, but there is the possibility of a good survival outcome when the administration of a small dose of adrenaline results in the rapid recovery of brainstem reflexes.
本研究旨在回顾性调查蛛网膜下腔出血（SAH）合并心肺骤停且实现自主循环恢复（ROSC）患者的临床特征，以探索长期生存的可能性。
对2004年4月至2012年6月期间我院143例发生心肺骤停的SAH患者进行分析，选取其中59例（41%）实现ROSC的患者数据，以确定神经功能恢复和预后的预测因素。记录到5例患者脑干反射恢复且格拉斯哥昏迷量表（GCS）运动评分改善（复苏后神经功能恢复评估，I级），其中2例存活。
按等级分析患者背景特征发现，I级患者的心脏骤停持续时间显著缩短（P = .001），肾上腺素剂量显著减小（P = .011）。对1周生存数据进行逻辑分析发现，心脏骤停持续时间（P = .022）和肾上腺素剂量（P = .019）存在显著差异，优势比分别为0.89和0.25。对死亡率数据进行Cox回归分析发现，心脏骤停持续时间（P = .012）、肾上腺素剂量（P < .0001）和ROSC位置（P = .016）存在显著差异，风险比分别为1.03、1.43和1.98。
SAH导致的心脏骤停是一种预后严重的疾病状态，但小剂量肾上腺素给药导致脑干反射快速恢复时，有可能获得良好的生存结局。
