[An analysis of relevant factors influencing the prognosis of post cardiac arrest syndrome].

OBJECTIVE

To investigate the relevant factors influencing the incidence and mortality of post cardiac arrest syndrome (PCAS), and to provide the basis of improvement of resuscitation rate.

METHODS

A single center retrospective study of cardiopulmonary resuscitation (CPR) according to Utstein model was conducted.A clinical case report form was designed to collect clinical data. The clinical data of patients whose spontaneous circulation was restored (ROSC) > 24 hours in intensive care unit (ICU) of the First Hospital of Jilin University from January 2008 to June 2014 were collected and analyzed. The relevant risk factors of the incidence and mortality rate of PCAS were screened and analyzed by multivariate logistic regression analysis.

RESULTS

(1) Successful CPR was achieved in 93 patients, of whom 83 patients were shown to have systemic inflammatory response syndrome (SIRS), and 75 patients suffered from PCAS (80.65%). Among them 49 died, and 18 patients who did not suffer from PCAS survived. (2) The age, gender, history of previous chronic disease, site of occurrence of cardiac arrest, type of rhythm when cardiac arrest occurred, and dosage of adrenaline showed no significant influence on the incidence of PCAS. The incidence of PCAS was elevated when defibrillation was done more than 3 times (χ² = 10.806, P = 0.001), SIRS occurred after ROSC (χ² = 46.687, P < 0.001), interval between collapse and first defibrillation over 5 minutes (χ² = 6.429, P = 0.011), interval between collapse and CPR longer than 5 minutes (χ² = 4.638, P = 0.031), interval between collapse and administration of first resuscitation medication > 5 minutes (χ² = 4.190, P = 0.041), and ROSC time was longer than 10 minutes (χ² = 20.042, P < 0.001). Bivariate correlation showed that interval between collapse and CPR, interval between collapse and administration of first resuscitation medications, and ROSC time were all correlated (r₁= 0.677, r₂= 0.481, r₃= 0.617, all P < 0.001). (3) There were no significant relations between the prognosis of PCAS patients and times of defibrillation, the amount of adrenaline used, and interval between collapse and first defibrillation. The mortality rate of PCAS was relatively elevated when interval between collapse and CRP was longer than 5 minutes (χ² = 10.792, P = 0.001), interval between collapse and administration of first resuscitation medications was longer than 5 minutes (χ² = 13.841, P < 0.001), ROSC time > 10 minutes (χ² = 36.451, P < 0.001), the number of dysfunction organ ≥ 4 (χ² = 28.287, P < 0.001), arterial blood lactate levels > 2 mmol/L (χ² = 28.926, P < 0.001), and acute physiology and chronic health evaluationII (APACHEII) score > 15 (χ² = 33.558, P < 0.001). Multivariate logistic regression analysis showed that the risk factors affecting the prognosis were ROSC time [odds ratio (OR) after adjustment = 36.643, 95% confidence interval (95% CI) = 2.382-563.767, P = 0.010], the number of organs with dysfunction (OR = 9.010, 95% CI = 1.140-71.199, P = 0.037), and APACHEII score (OR = 10.001, 95%CI = 1.336-74.893, P = 0.025).

CONCLUSIONS

ROSC time, the number of organs with dysfunction, and APACHEII score were independent predictors of PCAS prognosis. Efforts should be given to shorten the rescue time, to shorten the time for restoring the spontaneous circulation, to prevent and treat SIRS after ROSC, and to protect the function of organs, in order to improve the prognosis of patients with PCAS.