Conlon Thomas W, Falkensammer Christine B, Hammond Rachel S, Nadkarni Vinay M, Berg Robert A, Topjian Alexis A
1Division of Pediatric Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Children's Hospital of Philadelphia-Westat Biostatistics & Data Management Core, Philadelphia, PA.
Pediatr Crit Care Med. 2015 Feb;16(2):146-54. doi: 10.1097/PCC.0000000000000305.
To characterize the association of hospital discharge survival with left ventricular systolic function evaluated by transthoracic echocardiography and vasoactive infusion support following return of spontaneous circulation after pediatric out-of-hospital cardiac arrest.
Retrospective case series.
Single-center tertiary care pediatric cardiac arrest and critical care referral center.
Consecutive out-of-hospital cardiac arrest patients less than 18 years surviving to PICU admission who had a transthoracic echocardiography obtained by the clinical team within 24 hours of admission from January 2006 to May 2012.
None.
Fifty-eight patients had a post-return of spontaneous circulation transthoracic echocardiography performed within 24 hours of admission. The median time from return of spontaneous circulation to echo was 6.5 hours (interquartile range, 4.7, 15.0 hr). Left ventricular systolic function was decreased in 24 of 58 patients (41%). The mortality rate was 67% (39 of 58). Thirty-six patients (62%) received vasoactive infusions at the time of transthoracic echocardiography, and increased vasopressor inotropic score was associated with increased mortality on univariate analysis (p < 0.001). After controlling for defibrillation, vasopressor inotropic score, and interaction between vasopressor inotropic score and left ventricular systolic function, decreased left ventricular systolic function was associated with increased mortality (odds ratio, 13.7; 95% CI, 1.54-122).
In patients receiving transthoracic echocardiography within the first 24 hours following return of spontaneous circulation after pediatric out-of-hospital cardiac arrest, decreased left ventricular systolic function and vasopressor use were common. Decreased left ventricular systolic function was associated with increased mortality.
描述小儿院外心脏骤停自主循环恢复后，经胸超声心动图评估的左心室收缩功能及血管活性药物输注支持与出院生存率之间的关联。
回顾性病例系列研究。
单中心三级儿科心脏骤停及重症监护转诊中心。
2006年1月至2012年5月期间，连续入住儿科重症监护病房（PICU）且年龄小于18岁的院外心脏骤停存活患者，临床团队在其入院后24小时内进行了经胸超声心动图检查。
无。
58例患者在入院后24小时内进行了自主循环恢复后的经胸超声心动图检查。自主循环恢复至超声心动图检查的中位时间为6.5小时（四分位间距为4.7至15.0小时）。58例患者中有24例（41%）左心室收缩功能下降。死亡率为67%（58例中的39例）。36例患者（62%）在经胸超声心动图检查时接受了血管活性药物输注，单因素分析显示血管升压药肌力评分升高与死亡率增加相关（p<0.001）。在控制除颤、血管升压药肌力评分以及血管升压药肌力评分与左心室收缩功能之间的相互作用后，左心室收缩功能下降与死亡率增加相关（比值比为13.7；95%可信区间为1.54至122）。
在小儿院外心脏骤停自主循环恢复后的最初24小时内接受经胸超声心动图检查患者中，左心室收缩功能下降和使用血管升压药较为常见。左心室收缩功能下降与死亡率增加相关。
