Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Resuscitation. 2018 Sep;130:67-72. doi: 10.1016/j.resuscitation.2018.07.006. Epub 2018 Jul 7.
Animal studies have demonstrated that hemodynamic-directed cardiopulmonary resuscitation (CPR) improves outcomes following cardiac arrest compared with the "one-size-fits-all" algorithm. We investigated whether body size of patients is correlated with outcomes of in-hospital cardiac arrest (IHCA).
A retrospective study in a single centre was conducted. Adult patients experiencing IHCA between 2006 and 2015 were screened. Body mass index (BMI) was calculated using body weight and height measured at hospital admission. Thoracic anteroposterior diameter (APD) was measured by analysing computed tomography images. Multivariate logistic regression analysis was used to study the associations between independent variables and outcomes. Generalised additive models were used to identify cut-off points for continuous variables.
A total of 766 patients were included, and 60.4% were male. Their mean age was 62.8 years. Mean BMI was 22.9 kg/m, and the mean thoracic APD was 21.4 cm. BMI > 23.2 kg/m was inversely associated with a favourable neurological outcome (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.13-0.68; p-value = 0.004), while thoracic APD was not. When the interaction term was analysed, BMI > 23.2 (kg/m) × thoracic APD > 18.5 (cm) was inversely associated with both a favourable neurological outcome (OR: 0.33, 95% CI: 0.16-0.69; p-value = 0.003) and survival to hospital discharge (OR: 0.46, 95% CI: 0.26-0.81; p-value = 0.007).
Higher BMI and thoracic APD was correlated with worse outcomes following IHCA. For those patients, it might be better to perform CPR under guidance of physiological parameters rather than a "one-size-fits-all" resuscitation algorithm to improve outcomes.
动物研究表明，与“一刀切”算法相比，血流动力学导向的心肺复苏（CPR）可改善心搏骤停后的结局。我们研究了患者的体型是否与院内心搏骤停（IHCA）的结局相关。
进行了一项单中心回顾性研究。筛选了 2006 年至 2015 年期间经历 IHCA 的成年患者。入院时测量体重和身高计算体重指数（BMI）。通过分析计算机断层扫描图像测量胸前后径（APD）。采用多变量逻辑回归分析研究独立变量与结局之间的关系。采用广义加性模型确定连续变量的临界点。
共纳入 766 例患者，其中 60.4%为男性，平均年龄为 62.8 岁。平均 BMI 为 22.9kg/m，平均胸 APD 为 21.4cm。BMI＞23.2kg/m 与良好的神经功能结局呈负相关（比值比[OR]：0.30，95%置信区间[CI]：0.13-0.68；p 值=0.004），而胸 APD 则不然。当分析交互项时，BMI＞23.2（kg/m）×胸 APD＞18.5（cm）与良好的神经功能结局（OR：0.33，95%CI：0.16-0.69；p 值=0.003）和出院存活率（OR：0.46，95%CI：0.26-0.81；p 值=0.007）均呈负相关。
较高的 BMI 和胸 APD 与 IHCA 后的不良结局相关。对于这些患者，使用生理参数指导 CPR 可能比“一刀切”的复苏算法更好，以改善结局。
