Department of Emergency Medicine, Beaumont Hospital-Troy, Troy, MI, United States.
Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
Am J Emerg Med. 2018 May;36(5):834-837. doi: 10.1016/j.ajem.2017.10.036. Epub 2017 Oct 17.
The role of circulatory support in the post-cardiac arrest period remains controversial. Our objective was to investigate the association between treatment with a percutaneous hemodynamic support device and outcome after admission for cardiac arrest.
We performed a retrospective study of adult patients with admission diagnosis of cardiac arrest or ventricular fibrillation (VF) from the Michigan Inpatient Database, treated between July 1, 2010, and June 30, 2013. Patient demographics, clinical characteristics, treatments, and disposition were electronically abstracted based on ICD-9 codes at the hospital level. Mixed-effects logistic regression models were fit to test the effect of percutaneous hemodynamic support device defined as either percutaneous left ventricular assist device (pLVAD) or intra-aortic balloon pump (IABP) on survival. These models controlled for age, sex, VF, myocardial infarction (MI), and cardiogenic shock with hospital modeled as a random effect.
A total of 103 hospitals contributed 4393 patients for analysis, predominately male (58.8%) with a mean age of 64.1years (SD 15.5). On univariate analysis, younger age, male sex, VF as the initial rhythm, acute MI, percutaneous coronary intervention, percutaneous hemodynamic support device, and absence of cardiogenic shock were associated with survival to discharge (each p<0.001). Mixed-effects logistic regressions revealed use of percutaneous hemodynamic support device was significantly associated with survival among all patients (OR 1.8 (1.28-2.54)), and especially in those with acute MI (OR 1.95 (1.31-2.93)) or cardiogenic shock (OR 1.96 (1.29-2.98)).
Treatment with percutaneous hemodynamic support device in the post-arrest period may provide left ventricular support and improve outcome.
循环支持在心脏骤停后阶段的作用仍存在争议。我们的目的是研究经皮血液动力学支持设备的治疗与心脏骤停后入院患者结局之间的关联。
我们对密歇根州住院患者数据库中的成年心脏骤停或心室颤动（VF）入院诊断患者进行了回顾性研究，治疗时间为 2010 年 7 月 1 日至 2013 年 6 月 30 日。根据医院水平的 ICD-9 代码，对患者的人口统计学、临床特征、治疗和处置情况进行电子提取。使用混合效应逻辑回归模型来检验经皮血液动力学支持设备（定义为经皮左心室辅助装置[pLVAD]或主动脉内球囊泵[IABP]）对生存的影响。这些模型通过医院的随机效应来控制年龄、性别、VF、心肌梗死（MI）和心源性休克对生存的影响。
共有 103 家医院贡献了 4393 例患者进行分析，患者以男性为主（58.8%），平均年龄为 64.1 岁（标准差 15.5）。在单变量分析中，年龄较小、男性、VF 作为初始节律、急性 MI、经皮冠状动脉介入治疗、经皮血液动力学支持设备和无心源性休克与出院时的生存相关（p<0.001）。混合效应逻辑回归显示，在所有患者中，使用经皮血液动力学支持设备与生存显著相关（OR 1.8（1.28-2.54）），尤其是在急性 MI（OR 1.95（1.31-2.93））或心源性休克（OR 1.96（1.29-2.98））患者中。
心脏骤停后使用经皮血液动力学支持设备可能提供左心室支持并改善结局。
