Spindelboeck Walter, Gemes Geza, Strasser Christa, Toescher Kathrin, Kores Barbara, Metnitz Philipp, Haas Josef, Prause Gerhard
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
Clinical Department of General Anaesthesiology, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Medical University of Graz, Austria.
Resuscitation. 2016 Sep;106:24-9. doi: 10.1016/j.resuscitation.2016.06.013. Epub 2016 Jun 18.
An arterial blood gas analysis (ABG) yields important diagnostic information in the management of cardiac arrest. This study evaluated ABG samples obtained during out-of-hospital cardiopulmonary resuscitation (OHCPR) in the setting of a prospective multicenter trial. We aimed to clarify prospectively the ABG characteristics during OHCPR, potential prognostic parameters and the ABG dynamics after return of spontaneous circulation (ROSC).
ABG samples were collected and instantly processed either under ongoing OHCPR performed according to current advanced life support guidelines or immediately after ROSC and data ware entered into a case report form along with standard CPR parameters.
During a 22-month observation period, 115 patients had an ABG analysis during OHCPR. In samples obtained under ongoing CPR, an acidosis was present in 98% of all cases, but was mostly of mixed hypercapnic and metabolic origin. Hypocapnia was present in only 6% of cases. There was a trend towards higher paO2 values in patients who reached sustained ROSC, and a multivariate regression analysis revealed age, initial rhythm, time from collapse to CPR initiation and the arterio-alveolar CO2 difference (AaDCO2) to be associated with sustained ROSC. ABG samples drawn immediately after ROSC demonstrated higher paO2 and unaltered pH and base excess levels compared with samples collected during ongoing CPR.
Our findings suggest that adequate ventilation and oxygenation deserve more research and clinical attention in the management of cardiac arrest and that oxygen uptake improves within minutes after ROSC. Hyperventilation resulting in arterial hypocapnia is not a major problem during OHCPR.
动脉血气分析（ABG）在心脏骤停的处理中可提供重要的诊断信息。本研究在一项前瞻性多中心试验中，对院外心肺复苏（OHCPR）期间采集的ABG样本进行了评估。我们旨在前瞻性地明确OHCPR期间的ABG特征、潜在的预后参数以及自主循环恢复（ROSC）后的ABG动态变化。
根据当前高级生命支持指南，在进行中的OHCPR期间采集ABG样本并立即处理，或者在ROSC后立即采集，同时将数据与标准心肺复苏参数一起录入病例报告表。
在22个月的观察期内，115例患者在OHCPR期间进行了ABG分析。在持续心肺复苏期间采集的样本中，98%的病例存在酸中毒，但大多为混合性高碳酸血症和代谢性酸中毒。仅6%的病例存在低碳酸血症。达到持续性ROSC的患者的动脉血氧分压（paO2）值有升高趋势，多因素回归分析显示年龄、初始心律、从心脏停搏到开始心肺复苏的时间以及动脉 - 肺泡二氧化碳分压差（AaDCO2）与持续性ROSC相关。与持续心肺复苏期间采集的样本相比，ROSC后立即采集的ABG样本显示paO2较高，pH值和碱剩余水平未改变。
我们的研究结果表明，在心脏骤停的处理中，充分的通气和氧合值得更多的研究和临床关注，并且在ROSC后数分钟内氧摄取会改善。在OHCPR期间，导致动脉低碳酸血症的过度通气不是主要问题。
