Cour Martin, Turc Jean, Madelaine Thomas, Argaud Laurent
Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d'Arsonval, 69437, Lyon Cedex 03, France.
Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, 69373, Lyon, France.
Ann Intensive Care. 2019 Apr 8;9(1):45. doi: 10.1186/s13613-019-0520-0.
Successfully resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and good-quality transplantable organs. We aimed to determine risk factors for evolution toward BD after OHCA. We analyzed adult patients admitted to an intensive care unit (ICU) who survived at least 24 h after an OHCA between 2005 and 2015. BD was defined according to international guidelines. Multivariate logistic regression was used to identify potential risk factors for BD available 24 h after OHCA.
A total of 214 patients were included (median age 68 years; sex ratio 1.25; non-shockable OHCA: 88%). Among these, 42 (19.6%) developed BD, while 22 (10.3%) were alive at 1 year with a good neurological outcome. Independent risk factors for BD were age (OR per year 0.95; 95% CI [0.92-0.98]), female gender (OR 2.34; 95% CI [1.02-5.35]), neurological cause of OHCA (OR 14.72; 95% CI [3.03-71.37]), duration of the low-flow period > 16 min (OR 2.94, 95% CI [1.21-7.16]) and need of vasoactive drugs at 24 h (OR 6.20, 95% CI [2.41-15.93]).
The study identified, in a population of OHCA with predominantly non-shockable initial rhythms, five simple risk factors independently associated with progression toward BD.
成功复苏的院外心脏骤停（OHCA）可能导致脑死亡（BD）以及高质量的可移植器官。我们旨在确定OHCA后发展为BD的危险因素。我们分析了2005年至2015年间入住重症监护病房（ICU）且在OHCA后至少存活24小时的成年患者。BD根据国际指南定义。采用多因素逻辑回归来识别OHCA后24小时时BD的潜在危险因素。
共纳入214例患者（中位年龄68岁；性别比1.25；不可电击心律的OHCA：88%）。其中，42例（19.6%）发展为BD，而22例（10.3%）在1年时存活且神经功能良好。BD的独立危险因素为年龄（每年OR 0.95；95%CI[0.92 - 0.98]）、女性（OR 2.34；95%CI[1.02 - 5.35]）、OHCA的神经病因（OR 14.72；95%CI[3.03 - 71.37]）、低血流期持续时间>16分钟（OR 2.94，95%CI[1.21 - 7.16]）以及24小时时需要血管活性药物（OR 6.20，95%CI[2.41 - 15.93]）。
该研究在以不可电击初始心律为主的OHCA人群中，确定了五个与发展为BD独立相关的简单危险因素。
