Department of Emergency Medicine, University of Washington, Seattle, WA, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA, United States.
Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA, United States.
Resuscitation. 2019 Feb;135:37-44. doi: 10.1016/j.resuscitation.2019.01.009. Epub 2019 Jan 14.
To define the incidence of the acute respiratory distress syndrome (ARDS) following out-of-hospital cardiac arrest (OHCA) and characterize its impact on outcome.
This was a retrospective cohort study conducted at two urban, tertiary, academic hospitals from 2007 to 2014. We included adults with non-traumatic OHCA and survived for ≥48 h. Patients who received mechanical ventilation for ≥24 h, had 2 consecutive arterial blood gases with a ratio of the partial pressure of oxygen to the fraction of inspired oxygen ≤300, and bilateral radiographic opacities within 48 h of hospital admission were defined as having ARDS. We examined the associations between ARDS and outcome using multivariable analyses and performed sensitivity analyses excluding patients with evidence of cardiac dysfunction.
Of 978 OHCA patients transported to the study hospitals, 600 were mechanically ventilated and survived ≥48 h. A total of 287 (48%, 95% CI 44-52%) met criteria for ARDS within 48 h of admission. There were no differences in demographics, OHCA etiology, or cardiac rhythm according to ARDS status. Patients with ARDS had higher hospital mortality, longer ICU stays, more ventilator days, and were less likely to survive with full neurologic recovery. Upon excluding patients with cardiac dysfunction, the incidence of ARDS was unchanged.
Nearly half of initial OHCA survivors develop ARDS within 48 h of hospital admission. ARDS was associated with poor outcome and increased resource utilization. OHCA should be considered among the traditional ARDS risk factors.
定义院外心脏骤停（OHCA）后急性呼吸窘迫综合征（ARDS）的发生率，并描述其对预后的影响。
这是一项 2007 年至 2014 年在两家城市三级学术医院进行的回顾性队列研究。我们纳入了非创伤性 OHCA 且存活时间≥48 小时的成年人。接受机械通气时间≥24 小时、连续两次动脉血气比值氧分压与吸入氧分数≤300、入院后 48 小时内双侧影像学混浊的患者被定义为患有 ARDS。我们使用多变量分析检查了 ARDS 与预后之间的关系，并进行了排除有心功能障碍证据的患者的敏感性分析。
在转运至研究医院的 978 例 OHCA 患者中，有 600 例接受机械通气且存活时间≥48 小时。共有 287 例（48%，95%CI 44-52%）在入院后 48 小时内符合 ARDS 标准。ARDS 状态与人口统计学、OHCA 病因或心律失常无差异。ARDS 患者的院内死亡率更高、ICU 入住时间更长、呼吸机使用天数更多，且完全神经功能恢复的存活率更低。排除有心功能障碍的患者后，ARDS 的发生率不变。
近一半的初始 OHCA 幸存者在入院后 48 小时内发生 ARDS。ARDS 与不良预后和资源利用增加有关。OHCA 应被视为传统 ARDS 危险因素之一。
