Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Resuscitation. 2019 Jun;139:76-83. doi: 10.1016/j.resuscitation.2019.03.036. Epub 2019 Apr 1.
Lower pH after out-of-hospital cardiac arrest (OHCA) has been associated with worsening neurologic outcome, with <7.2 identified as an "unfavorable resuscitation feature" in consensus treatment algorithms despite conflicting data. This study aimed to describe the relationship between decremental post-resuscitation pH and neurologic outcomes after OHCA.
Consecutive OHCA patients treated with targeted temperature management (TTM) at multiple US centers from 2008 to 2017 were evaluated. Poor neurologic outcome at hospital discharge was defined as cerebral performance category ≥3. The exposure was initial arterial pH after return of spontaneous circulation (ROSC) analyzed in decremental 0.05 thresholds. Potential confounders (demographics, history, resuscitation characteristics, initial studies) were defined a priori and controlled for via ATT-weighting on the inverse propensity score plus direct adjustment for the linear propensity score.
Of 723 patients, 589 (80%) experienced poor neurologic outcome at hospital discharge. After propensity-adjustment with excellent covariate balance, the adjusted odds ratios for poor neurologic outcome by pH threshold were: ≤7.3: 2.0 (1.0-4.0); ≤7.25: 1.9 (1.2-3.1); ≤7.2: 2.1 (1.3-3.3); ≤7.15: 1.9 (1.2-3.1); ≤7.1: 2.4 (1.4-4.1); ≤7.05: 3.1 (1.5-6.3); ≤7.0: 4.5 (1.8-12).
No increased hazard of progressively poor neurologic outcomes was observed in resuscitated OHCA patients treated with TTM until the initial post-ROSC arterial pH was at least ≤7.1. This threshold is more acidic than in current guidelines, suggesting the possibility that post-arrest pH may be utilized presently as an inappropriately-pessimistic prognosticator.
院外心脏骤停（OHCA）后 pH 值较低与神经功能预后恶化相关，尽管存在矛盾数据，但共识治疗算法将<7.2 确定为“不利的复苏特征”。本研究旨在描述 OHCA 后复苏后 pH 值逐渐下降与神经功能结局之间的关系。
评估了 2008 年至 2017 年期间美国多个中心接受目标温度管理（TTM）治疗的连续 OHCA 患者。出院时神经功能不良定义为脑功能分类≥3。暴露因素为自主循环恢复（ROSC）后初始动脉 pH 值，以 0.05 的递减阈值进行分析。潜在混杂因素（人口统计学、病史、复苏特征、初始研究）在事先定义，并通过逆倾向评分加权和线性倾向评分的直接调整进行控制。
在 723 例患者中，589 例（80%）出院时神经功能不良。在进行倾向调整并具有极好的协变量平衡后，pH 值阈值的不良神经功能结局的调整比值比为：≤7.3：2.0（1.0-4.0）；≤7.25：1.9（1.2-3.1）；≤7.2：2.1（1.3-3.3）；≤7.15：1.9（1.2-3.1）；≤7.1：2.4（1.4-4.1）；≤7.05：3.1（1.5-6.3）；≤7.0：4.5（1.8-12）。
在接受 TTM 治疗的 OHCA 患者中，直到初始 ROSC 动脉 pH 值至少≤7.1 时，未观察到神经功能不良结局逐渐恶化的风险增加。这一阈值比目前的指南更酸，这表明复苏后 pH 值可能目前被用作不恰当的悲观预后指标。
