Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France.
Medical Intensive Care Unit, Lariboisière Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
Crit Care Med. 2018 Aug;46(8):e751-e760. doi: 10.1097/CCM.0000000000003196.
Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early predictors of convulsive status epilepticus-related cardiac arrest.
Retrospective multicenter study.
Seventeen university or university affiliated participating ICUs in France and Belgium.
Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus between 2000 and 2015. Patients were compared with controls without cardiac arrest identified in a single-center registry of convulsive status epilepticus patients, regarding characteristics, management, and outcome.
None.
We included 49 cases with convulsive status epilepticus-cardiac arrest and 235 controls. In the cases, median time from medical team arrival to cardiac arrest was 25 minutes (interquartile range, 5-85 min). First recorded rhythm was asystole in 25 patients (51%) and pulseless electrical activity in 13 patients (27%). A significantly larger proportion of patients had a favorable 1-year outcome (Glasgow Outcome Scale score of 5) among controls (90/235; 38%) than among cases (10/49; 21%; p = 0.02). By multivariate analysis, independent predictors of cardiac arrest were pulse oximetry less than 97% on scene (odds ratio, 2.66; 95% CI, 1.03-7.26; p = 0.04), drug poisoning as the cause of convulsive status epilepticus (odds ratio, 4.13; 95% CI, 1.27-13.53; p = 0.02), and complications during early management (odds ratio, 11.98; 95% CI, 4.67-34.69; p < 0.0001). Having at least one comorbidity among cardiac, respiratory, and neurologic (other than epilepsy) conditions predicted absence of cardiac arrest (odds ratio, 0.28; 95% CI, 0.10-0.80; p = 0.02).
In patients managed for convulsive status epilepticus, relative hypoxemia, on-scene management complications, and drug poisoning as the cause of convulsive status epilepticus were strong early predictors of cardiac arrest, suggesting areas for improvement.
心跳骤停是一种灾难性事件，可能发生在癫痫持续状态的管理过程中。我们旨在报告与癫痫持续状态相关心跳骤停的临床特征、结局和早期预测因素。
回顾性多中心研究。
法国和比利时的 17 家大学或大学附属重症监护病房。
2000 年至 2015 年间，在参与单位接受治疗的因院外心脏骤停而成功复苏并伴有癫痫持续状态初始管理的患者中，连续纳入因心脏骤停而住院的患者。将这些患者与在单一中心癫痫持续状态患者登记处确定的无心脏骤停的对照组进行比较，比较特征、治疗和结局。
无。
共纳入 49 例癫痫持续状态伴心跳骤停和 235 例对照组患者。在病例中，从医疗队到达至心跳骤停的中位时间为 25 分钟（四分位间距，5-85 分钟）。25 例患者（51%）首次记录的节律为心搏停止，13 例患者（27%）为无脉电活动。在对照组中（90/235；38%），有更好的 1 年结局（格拉斯哥预后量表评分为 5）的患者比例显著高于病例组（10/49；21%；p=0.02）。多变量分析显示，现场脉搏血氧饱和度<97%（比值比，2.66；95%置信区间，1.03-7.26；p=0.04）、癫痫持续状态的病因是药物中毒（比值比，4.13；95%置信区间，1.27-13.53；p=0.02）和早期管理期间出现并发症（比值比，11.98；95%置信区间，4.67-34.69；p<0.0001）是心跳骤停的独立预测因素。存在心脏、呼吸和神经系统（除癫痫外）疾病至少一种合并症预测无心跳骤停（比值比，0.28；95%置信区间，0.10-0.80；p=0.02）。
在接受癫痫持续状态治疗的患者中，相对低氧血症、现场管理并发症和药物中毒是心跳骤停的强烈早期预测因素，提示需要改进。
