Terman Samuel W, Hume Benjamin, Meurer William J, Silbergleit Robert
1Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI. 2Department of Neurology, University of Michigan Medical School, Ann Arbor, MI.
Crit Care Med. 2014 Oct;42(10):2225-34. doi: 10.1097/CCM.0000000000000506.
To compare short- and long-term neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest treated with mild therapeutic hypothermia presenting with nonshockable versus shockable initial rhythms.
Retrospective cohort study.
Emergency department and ICU of an academic hospital.
One hundred twenty-three consecutive post-out-of-hospital cardiac arrest adults (57 nonshockable rhythms, 66 shockable rhythms) treated with therapeutic hypothermia between 2006 and 2012.
None.
Data were collected from electronic health records. Neurologic outcomes were dichotomized by Cerebral Performance Category at discharge and 6- to 12-month follow-up and analyzed via multivariable logistic regressions. Groups were similar, except nonshockable rhythm patients were more likely to have a history of diabetes mellitus (p = 0.01), be dialysis dependent (p = 0.01), and not have bystander cardiopulmonary resuscitation (p = 0.05). At discharge, 3 of 57 patients (5%) with nonshockable rhythm versus 28 of 66 (42%) with shockable rhythm had a favorable outcome (unadjusted odds ratio, 0.08; 95% CI, 0.02-0.3; adjusted odds ratio, 0.1; 95% CI, 0.03-0.4). At follow-up, 4 of 55 patients (7%) versus 29 of 60 (48%) with nonshockable rhythm and shockable rhythm, respectively, had a favorable Cerebral Performance Category (odds ratio, 0.08; 95% CI, 0.03-0.3; adjusted odds ratio, 0.09; 95% CI, 0.09-0.3). Among those surviving hospitalization, favorable neurologic outcome was more likely at long-term follow-up than at hospital discharge for both groups (odds ratio, 2.5; 95% CI, 1.3-4.7; adjusted odds ratio, 2.9; 95% CI, 1.4-6.2). No significant interaction between changes in neurologic status over time and presenting rhythm was seen (p = 0.93).
These data indicate an association between initial nonshockable rhythm and significantly worse short- and long-term outcomes in patients treated with mild therapeutic hypothermia. Among survivors, neurologic status significantly improved over time for all patients and shockable rhythm patients and tended to improve over time for the small number of nonshockable rhythm patients who survived beyond hospitalization. No significant interaction between changes in neurologic status over time and presenting rhythm was seen.
比较接受轻度治疗性低温治疗的院外心脏骤停昏迷幸存者中，初始节律为不可电击复律与可电击复律者的短期和长期神经学转归。
回顾性队列研究。
一所学术医院的急诊科和重症监护病房。
2006年至2012年间连续123例接受治疗性低温治疗的院外心脏骤停成年患者（57例为不可电击复律节律，66例为可电击复律节律）。
无。
从电子健康记录中收集数据。神经学转归根据出院时及6至12个月随访时的脑功能分类进行二分法划分，并通过多变量逻辑回归分析。两组患者情况相似，但不可电击复律节律患者更可能有糖尿病病史（p = 0.01）、依赖透析（p = 0.01）且未接受旁观者心肺复苏（p = 0.05）。出院时，57例不可电击复律节律患者中有3例（5%）转归良好，而66例可电击复律节律患者中有28例（42%）转归良好（未调整优势比为0.08；95%置信区间为0.02 - 0.3；调整后优势比为0.1；95%置信区间为0.03 - 0.4）。随访时，55例不可电击复律节律患者中有4例（7%），60例可电击复律节律患者中有29例（48%）脑功能分类转归良好（优势比为0.08；95%置信区间为0.03 - 0.3；调整后优势比为0.09；95%置信区间为0.09 - 0.3）。在存活至出院的患者中，两组患者长期随访时神经学转归良好的可能性均高于出院时（优势比为2.5；95%置信区间为1.3 - 4.7；调整后优势比为2.9；95%置信区间为1.4 - 6.2）。未观察到神经学状态随时间变化与初始节律之间存在显著交互作用（p = 0.93）。
这些数据表明，初始节律为不可电击复律与接受轻度治疗性低温治疗患者的短期和长期转归显著较差之间存在关联。在幸存者中，所有患者及可电击复律节律患者的神经学状态随时间显著改善，少数存活至出院后的不可电击复律节律患者的神经学状态也有改善趋势。未观察到神经学状态随时间变化与初始节律之间存在显著交互作用。
