Kocjancic Spela Tadel, Jazbec Anja, Noc Marko
Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
Resuscitation. 2014 Oct;85(10):1364-9. doi: 10.1016/j.resuscitation.2014.06.028. Epub 2014 Jul 8.
We investigated the impact of intensified postresuscitation treatment in comatose survivors of out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology according to the initial rhythm at the emergency medical team arrival.
Interventions and survival with Cerebral Performance Category (CPC) 1-2 within each group were retrospectively compared between the periods of conservative (1995-2003) and intensified (2004-2012) postresuscitation treatment.
In shockable group, therapeutic hypothermia (TH) increased from 1 to 93%, immediate invasive coronary strategy from 28 to 78%, intraaortic balloon pump from 4 to 21%, vasopressors/inotropes from 47 to 81% and antimicrobial agents from 65 to 86% during the intensified period as compared to conservative period (p<0.001). This was associated with increased survival with CPC 1-2 from 27 to 47% (p<0.001). After adjusting for age, sex and prehospital confounders, TH (OR=2.12, 95% CI 1.25-3.61), percutaneous coronary intervention (OR 1.77, 95% CI 1.15-2.73) and antimicrobial agents (OR=12.21, 95% CI 5.13-29.08) remained associated with survival with CPC 1-2. In non-shockable patients, TH also significantly increased from 1 to 74%, immediate invasive coronary strategy from 8 to 51%, intraaortic balloon pump from 2 to 9% and vasopressors/inotropes from 56 to 84% during intensified period without concomitant increase in survival with CPC 1-2 (7% vs. 9%; p=0.27). After adjustment, only antimicrobial agents (OR=8.43, 95% CI: 1.05-67.72) remained associated with survival with CPC 1-2.
Intensified postresuscitation treatment was associated with doubled survival in comatose survivors of OHCA with shockable rhythm. Such association could not be demonstrated in patients with non-shockable rhythm.
我们根据急救医疗队到达时的初始心律，研究了强化复苏后治疗对推测为心源性病因的院外心脏骤停（OHCA）昏迷幸存者的影响。
回顾性比较了保守治疗期（1995 - 2003年）和强化治疗期（2004 - 2012年）每组内的干预措施及脑功能分类（CPC）为1 - 2级的存活情况。
在可除颤组中，与保守治疗期相比，强化治疗期治疗性低温（TH）从1%增至93%，即刻侵入性冠状动脉策略从28%增至78%，主动脉内球囊反搏从4%增至21%，血管升压药/正性肌力药从47%增至81%，抗菌药物从65%增至86%（p<0.001）。这与CPC为1 - 2级的存活率从27%增至47%相关（p<0.001）。在对年龄、性别和院前混杂因素进行校正后，TH（比值比[OR]=2.12，95%置信区间[CI] 1.25 - 3.61）、经皮冠状动脉介入治疗（OR 1.77，95% CI 1.15 - 2.73）和抗菌药物（OR=12.21，95% CI 5.13 - 29.08）仍与CPC为1 - 2级的存活相关。在不可除颤患者中，强化治疗期TH也显著从1%增至74%，即刻侵入性冠状动脉策略从8%增至51%，主动脉内球囊反搏从2%增至9%，血管升压药/正性肌力药从56%增至84%，但CPC为1 - 2级的存活率未随之增加（7%对9%；p = 0.27）。校正后，只有抗菌药物（OR=8.43，95% CI：1.05 - 67.72）仍与CPC为1 - 2级的存活相关。
强化复苏后治疗与OHCA可除颤心律昏迷幸存者的存活率翻倍相关。在不可除颤心律患者中未证实这种关联。
