Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
Crit Care Med. 2018 Oct;46(10):e995-e1001. doi: 10.1097/CCM.0000000000003352.
Recent data suggest that early increased fibrinolysis may be associated with unfavorable prognosis in cardiac arrest. The current study aimed to assess whether there is an optimal fibrinolysis cutoff value as determined by thrombelastometry at hospital admission to predict poor outcome in a cohort of adult patients with out-of-hospital cardiac arrest.
Prospective observational cohort study.
Emergency department of a 2.100-bed tertiary care facility in Vienna, Austria, Europe.
Patients with out-of-hospital cardiac arrest of presumed cardiac origin, subjected to targeted temperature management, who had achieved return of spontaneous circulation at admission were analyzed.
None.
Fibrinolysis was assessed by thrombelastometry at the bedside immediately after hospital admission and is given as maximum lysis (%). The outcome measure was the optimal cutoff for maximum lysis at hospital admission to predict poor outcome (a composite of Cerebral Performance Category 3-5 or death) at day 30, assessed by receiver operating characteristic curve analysis. Seventy-eight patients (61% male, median 59 yr) were included in the study from March 2014 to March 2017. Forty-two patients (54%) had a poor 30-day outcome including 23 nonsurvivors (30%). The maximum lysis cutoff at admission predicting poor 30-day outcome with 100% specificity (95% CI, 90-100%) was greater than or equal to 20%. Tissue-type plasminogen activator antigen levels were likewise elevated in patients with poor neurologic outcome or death 52 ng/mL (interquartile range, 26-79 ng/mL) versus 29 ng/mL (interquartile range, 17-49 ng/mL; p = 0.036).
Increased fibrinolysis at admission assessed by thrombelastometry specifically predicts poor outcome in cardiac arrest with presumed cardiac etiology.
最近的数据表明，心脏骤停患者早期纤溶活性增强可能与预后不良有关。本研究旨在评估入院时血栓弹力图测定的纤溶最佳截断值是否可预测一大组院外心脏骤停成年患者的不良结局。
前瞻性观察性队列研究。
欧洲奥地利维也纳一家 2100 床位的三级护理设施的急诊部。
接受目标温度管理的、假定心源性院外心脏骤停且入院时已恢复自主循环的患者。
无。
入院时床边通过血栓弹力图即刻评估纤溶，并以最大纤溶（%）表示。结局测量指标是入院时最大纤溶的最佳截断值，以预测 30 天时不良结局（通过接受者操作特征曲线分析评估的脑功能分类 3-5 或死亡的复合终点）。2014 年 3 月至 2017 年 3 月，本研究共纳入 78 例患者（61%为男性，中位年龄 59 岁）。42 例患者（54%）预后不良，包括 23 例死亡（30%）。入院时最大纤溶截断值预测 30 天不良结局的特异性为 100%（95%CI，90-100%），截断值大于或等于 20%。不良神经结局或死亡患者的组织型纤溶酶原激活物抗原水平也升高，分别为 52ng/mL（四分位间距，26-79ng/mL）和 29ng/mL（四分位间距，17-49ng/mL；p=0.036）。
入院时血栓弹力图评估的纤溶活性增强特异性预测了假定心源性病因心脏骤停患者的不良结局。
