Kumagai Kazumi, Oda Yasutaka, Oshima Chiyomi, Kaneko Tadashi, Kaneda Kotaro, Kawamura Yoshikatsu, Ogino Yasuaki, Yamashita Susumu, Ichihara Kiyoshi, Maekawa Tsuyoshi, Tsuruta Ryosuke
Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Yamaguchi Japan.
Department of Stress and Bio-response Medicine Yamaguchi University Graduate School of Medicine Ube Yamaguchi Japan.
Acute Med Surg. 2014 Dec 10;2(3):176-182. doi: 10.1002/ams2.96. eCollection 2015 Jul.
Early prediction of the neurological outcomes of patients with out-of-hospital cardiac arrest is important to select the optimal clinical management. We hypothesized that clinical data recorded at the site of cardiopulmonary resuscitation would be clinically useful.
This retrospective cohort study included patients with return of spontaneous circulation after cardiopulmonary resuscitation who were admitted to our university hospital between January 2000 and November 2013 or two affiliated hospitals between January 2006 and November 2013. Clinical parameters recorded on arrival included age (A), arterial blood pH (B), time from cardiopulmonary resuscitation to return of spontaneous circulation (C), pupil diameter (D), and initial rhythm (E). Glasgow Outcome Scale was recorded at 6 months and a favorable neurological outcome was defined as a score of 4-5 on the Glasgow Outcome Scale. Multiple logistic regression analysis was carried out to derive a formula to predict neurological outcomes based on basic clinical parameters.
The regression equation was derived using a teaching dataset (total, = 477; favourable outcome, = 55): EP = 1/(1 + e ), where EP is the estimated probability of having a favorable outcome, and = (-0.023 × A) + (3.296 × B) - (0.070 × C) - (1.006 × D) + (2.426 × E) - 19.489. The sensitivity, specificity, and accuracy were 80%, 92%, and 90%, respectively, for the validation dataset (total, = 201; favourable outcome, = 25).
The 6-month neurological outcomes can be predicted in patients resuscitated from out-of-hospital cardiac arrest using clinical parameters that can be easily recorded at the site of cardiopulmonary resuscitation.
对院外心脏骤停患者的神经功能结局进行早期预测，对于选择最佳临床管理方案具有重要意义。我们推测，在心肺复苏现场记录的临床数据会具有临床实用价值。
这项回顾性队列研究纳入了2000年1月至2013年11月期间入住我校医院或2006年1月至2013年11月期间入住两所附属医院、心肺复苏后恢复自主循环的患者。到达时记录的临床参数包括年龄（A）、动脉血pH值（B）、从心肺复苏到恢复自主循环的时间（C）、瞳孔直径（D）和初始心律（E）。在6个月时记录格拉斯哥预后评分，良好的神经功能结局定义为格拉斯哥预后评分为4 - 5分。进行多因素逻辑回归分析，以得出基于基本临床参数预测神经功能结局的公式。
使用一个教学数据集（共477例；良好结局55例）得出回归方程：EP = 1/(1 + e )，其中EP是具有良好结局的估计概率， = (-0.023×A) + (3.296×B) - (0.070×C) - (1.006×D) + (2.426×E) - 19.489。验证数据集（共201例；良好结局25例）的敏感性、特异性和准确性分别为80%、92%和90%。
利用可在心肺复苏现场轻松记录的临床参数，能够预测院外心脏骤停复苏患者6个月时的神经功能结局。
