López-Herce Jesús, del Castillo Jimena, Matamoros Martha, Canadas Sonia, Rodriguez-Calvo Ana, Cecchetti Corrado, Rodríguez-Núnez Antonio, Carrillo Ángel
Crit Care. 2014 Nov 3;18(6):607. doi: 10.1186/s13054-014-0607-9.
Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children.
A prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality.
Return of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80.
Secondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.
大多数研究分析了儿童心脏骤停（CA）后与死亡率相关的骤停前和复苏因素，但许多实现自主循环恢复的患者会在接下来的数天或数周内死亡。我们研究的目的是分析儿童心脏骤停后与院内死亡率相关的自主循环恢复后因素。
在来自12个国家的48家医院进行了一项前瞻性多中心、跨国观察性研究。共分析了502例年龄在1个月至18岁之间的院内心脏骤停儿童。主要终点是存活至出院。进行单因素和多因素逻辑回归分析，以评估每个自主循环恢复后因素对死亡率的影响。
69.5%的患者实现了自主循环恢复；39.2%存活至出院，88.9%的幸存者有良好的神经功能预后。在单因素分析中，与死亡率相关的自主循环恢复后因素有pH值、碱缺失、乳酸、碳酸氢盐、吸入氧分数（FiO2）、是否需要血管活性药物支持、血管活性指数、自主循环恢复后1小时和24小时的多巴胺和多巴酚丁胺剂量，以及儿科重症监护病房住院时间和总住院时间。在多因素分析中，自主循环恢复后1小时与死亡率相关的因素是动脉血二氧化碳分压（PaCO2）<30 mmHg和>50 mmHg、血管活性指数>14以及乳酸>5 mmol/L。自主循环恢复后24小时与死亡率相关的因素是PaCO2>50 mmHg、血管活性指数>14以及FiO2≥0.80。
CA初始幸存者中的院内二次死亡率很高。通气不足、通气过度、FiO2≥0.80、需要高剂量血管活性药物支持以及高乳酸水平是我们研究人群中与儿童院内死亡率相关的最重要的自主循环恢复后因素。
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