Barauskas Mindaugas, Unikas Ramūnas, Žiubrytė Greta
Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Arch Med Sci Atheroscler Dis. 2018 Feb 2;3:e1-e7. doi: 10.5114/amsad.2018.73212. eCollection 2018.
As coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors.
Patients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study.
One hundred thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion ( = 0.044), but an effect of revascularization on number of deaths was not observed ( = 0.64). The presence of coma ( = 0.005) and the combination of male sex and age above 60-year as 2.2-fold ( = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98-21.63; = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25-6.90; = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96-21.24; = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63-13.66; < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9-6.72; = 0.031) to be significant prognostic factors for higher in-hospital mortality rate.
We recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.
由于冠状动脉疾病是心脏骤停最常见的原因，早期侵入性策略可能对此类患者有益。本研究分析了院内治疗对院外心脏骤停（OHCA）幸存者短期预后的影响。
前瞻性纳入我院心脏重症监护病房在2年内收治的患者。
131例患者纳入本研究，结果显示院内死亡率随冠状动脉病变严重程度的增加而均匀上升（P = 0.044），但未观察到血运重建对死亡人数的影响（P = 0.64）。发现昏迷（P = 0.005）以及男性且年龄超过60岁使院内死亡率增加2.2倍（P = 0.048）。最高死亡率发生在最初3天内，度过此期的患者死亡率较低。我们发现左心室射血分数降低（OR = 6.54；95%CI：1.98 - 21.63；P = 0.002）、非室颤初始心律（OR = 2.94；95%CI：1.25 - 6.90；P = 0.014）、入院时无意识（OR = 6.46；95%CI：1.96 - 21.24；P = 0.002）以及复苏后昏迷（OR = 6.00；95%CI：2.63 - 13.66；P < 0.001）或脑病（OR = 2.71；95%CI：1.9 - 6.72；P = 0.031）是院内死亡率较高的显著预后因素。
我们建议对所有OHCA幸存者立即进行冠状动脉干预，无论其意识状态及心电图有无缺血改变。OHCA患者的早期强化治疗必不可少，因为最高死亡率发生在事件后的最初3天内。
