Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, United States.
Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, United States.
Resuscitation. 2018 Apr;125:99-103. doi: 10.1016/j.resuscitation.2018.02.001. Epub 2018 Feb 6.
Little is known about hemodynamics in adult, out-of-hospital (OHCA) patients following return of spontaneous circulation (ROSC). A 1994 study when "high-dose epinephrine" use was common showed consistently elevated systemic vascular resistance (SVR) lasting ≥6 h in 49 adult patients after return of spontaneous circulation (ROSC).
To characterize hemodynamic abnormalities in adult OHCA patients soon after ROSC. Our hypothesis was that, unlike the consistently high SVR values reported when "high-dose" epinephrine was in common use, there would be a more heterogenous distribution of SVR values using current adrenergic therapy.
We included adult, OHCA patients transported by paramedics to the Emergency Department (ED) post-ROSC. Children, prisoners, pregnant women, and those with ongoing CPR or arrest due to traumatic injury were excluded. Hemodynamics were recorded non-invasively as soon as feasible after ED arrival but were not used to influence therapy, which was guided by clinical judgment of treating ED physicians.
Hemodynamics were recorded on 30 patients 20 [16,25] minutes after ED arrival: 50% had a normal SVR, 30% had a high SVR, and 20% had a low SVR. There was no difference in survival to admission among groups, although there was a difference among groups in survival to discharge. Comparing the low SVR group vs the combined normal and high group revealed a trend for fewer 0/6 (0%) low vs. 10/24 (42%) normal or high SVR patients surviving to hospital discharge (p = .053).
A heterogeneous range of hemodynamic states exist post-ROSC rather than consistent vasoconstriction. Adequately powered, randomized clinical trials will be needed to determine whether noninvasively-derived, hemodynamic-directed therapy can play a role in improving neurologically-intact survival following OHCA in adults.
对于恢复自主循环（ROSC）后的成人院外心脏骤停（OHCA）患者的血液动力学知之甚少。一项 1994 年的研究表明，在使用“高剂量肾上腺素”普遍的情况下，49 名成人 ROSC 后持续≥6 小时的全身性血管阻力（SVR）持续升高。
描述 ROSC 后不久成人 OHCA 患者的血液动力学异常。我们的假设是，与使用“高剂量”肾上腺素时报告的一致高 SVR 值不同，使用当前的肾上腺素治疗时，SVR 值的分布将更加不均匀。
我们纳入了由护理人员转运到急诊科（ED）后 ROSC 的成年 OHCA 患者。排除儿童、囚犯、孕妇以及因创伤性损伤而持续进行心肺复苏或因心脏骤停而进行复苏的患者。在 ED 到达后尽快进行非侵入性血液动力学监测，但不用于影响治疗，治疗由治疗 ED 医生的临床判断指导。
在 ED 到达后 20 [16,25] 分钟记录了 30 名患者的血液动力学：50%的患者 SVR 正常，30%的患者 SVR 高，20%的患者 SVR 低。各组之间的存活率无差异，但各组之间的出院存活率有差异。将低 SVR 组与正常和高 SVR 组进行比较，发现低 SVR 组存活至出院的患者（0%）少于正常或高 SVR 组（42%）的患者（p=0.053）。
ROSC 后存在多种血液动力学状态，而不是持续的血管收缩。需要进行充分的、随机的临床试验，以确定非侵入性获得的、基于血液动力学的治疗是否可以在改善成人 OHCA 后的神经完整存活方面发挥作用。
