体外心肺复苏后高氧血症与院外心脏骤停患者死亡率的关系。
Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest.
机构信息
Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.
Intensive Care Unit, Anaesthesiology Department and SAMU of Paris, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
出版信息
Am J Emerg Med. 2020 May;38(5):900-905. doi: 10.1016/j.ajem.2019.07.008. Epub 2019 Jul 8.
OBJECTIVE
Assess whether elevated oxygen partial arterial pressure (PaO2) measured after the initiation of extra-corporeal cardiopulmonary resuscitation (eCPR), is associated with mortality in patients suffering from refractory out-of-hospital cardiac arrest (rOHCA).
METHODS
Retrospective cohort study including rOHCA admitted to the ICU. Patients were divided into 3 groups, defined according to the PaO2 measured from arterial blood gas analysis 30 min after the initiation of eCPR. Hyperoxemia was defined as PaO2 ≥ 300 mmHg, hypoxemia as PaO2 ≤ 60 mmHg and normoxemia, as 60 < PaO2 < 300 mmHg. The main outcome was the mortality rate on day 28 after hospital admission.
RESULTS
Sixty-six consecutive rOHCA, 77% male, with a mean age of 51 ± 14 years, were admitted to the ICU. rOHCA were mainly due to acute coronary syndrome (67%), hypertrophic cardiomyopathy (8%) and cardiotoxic overdose (8%). Mortality at day 28 reached 61%. In the overall population, the mean PaO2 was 227 ± 124 mmHg. An association between mortality and PaO2 was observed (OR = 1.01 [1.01-1.02]). The AUC for PaO2 after starting eCPR was 0.77 [0.65-0.89]. After adjustment for witnessed arrest, bystander's CPR, location, no-flow, low-flow, lactate and pH, age, and PaCO, hyperoxemia had an ORa of 1.89 (CI95 [1.74-2.07]).
CONCLUSION
We found an association between mortality and hyperoxemia in patients admitted to the ICU for rOHCA requiring eCPR. These data underline the potential toxicity of high dose of oxygen and suggest that controlled oxygen administration for these patients is crucial.
目的
评估体外心肺复苏（eCPR）开始后测量的动脉氧分压（PaO2）升高与难治性院外心脏骤停（rOHCA）患者的死亡率是否相关。
方法
回顾性队列研究纳入 rOHCA 患者，这些患者被收入 ICU。根据 eCPR 开始后 30 分钟动脉血气分析测量的 PaO2，将患者分为 3 组。高氧血症定义为 PaO2≥300mmHg，低氧血症定义为 PaO2≤60mmHg，氧合正常定义为 60<PaO2<300mmHg。主要结局是入院后第 28 天的死亡率。
结果
连续纳入 66 例 rOHCA 患者，77%为男性，平均年龄为 51±14 岁，主要病因是急性冠状动脉综合征（67%）、肥厚型心肌病（8%）和心脏毒性药物过量（8%）。第 28 天死亡率为 61%。在总体人群中，平均 PaO2 为 227±124mmHg。死亡率与 PaO2 之间存在相关性（OR=1.01[1.01-1.02]）。eCPR 开始后 PaO2 的 AUC 为 0.77[0.65-0.89]。在校正目击性骤停、旁观者心肺复苏、位置、无血流、低血流、乳酸和 pH 值、年龄和 PaCO2 后，高氧血症的 ORa 为 1.89（95%CI[1.74-2.07]）。
结论
我们发现 rOHCA 患者在需要 eCPR 治疗的 ICU 中，死亡率与高氧血症相关。这些数据强调了高剂量氧气的潜在毒性，并提示这些患者的氧合控制至关重要。
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