American Heart of Poland Inc. Center for Cardiovascular Research and Development, Poland.
Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Eur Heart J Acute Cardiovasc Care. 2020 Nov;9(4_suppl):S110-S121. doi: 10.1177/2048872619895126. Epub 2020 Jan 31.
Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality.
The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay.
Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001-1.070); 0.043, white blood cells 1.086 (1.039-1.136); 0.001, platelets 1.004 (1.001-1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496-6.725; 0.002) and to short-term mortality (3.335 (1.815-6.129); 0.0001).
An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.
尽管肺部可能极易受到心脏骤停后综合征损伤的影响，但院外心脏骤停后急性呼吸衰竭的问题尚未得到调查。本分析的目的是确定院外心脏骤停后急性呼吸衰竭的发生率，其与心脏骤停后综合征炎症反应的关系，并阐明其对早期死亡率的重要性。
心脏骤停后综合征（PCAS）试验是一项前瞻性、观察性、六中心项目（波兰 2 个、丹麦 1 个、西班牙 1 个、意大利 1 个、英国 1 个），研究对象为院外心源性心脏骤停后复苏的患者。主要结局为：（a）院外心脏骤停后 72 小时内器官衰竭的情况；（b）院内和短期死亡率，随访至 30 天。呼吸衰竭采用柏林急性呼吸窘迫综合征定义的改良版本定义。炎症反应采用白细胞（白细胞）、血小板计数和 C 反应蛋白浓度来定义。所有参数均在入院后至 72 小时内每 24 小时评估一次。
共纳入 148 例患者（年龄 62.9±15.27 岁；27.7%为女性）。在最初的 72 小时内，有 50（33.8%）至 75 例（50.7%）患者出现急性呼吸衰竭。院内和短期死亡率分别为 68（46.9%）和 72（48.6%）。炎症与急性呼吸衰竭的风险显著相关，72 小时时累积优势比最高，为 748（C 反应蛋白 1.035（1.001-1.070）；0.043，白细胞 1.086（1.039-1.136）；0.001，血小板 1.004（1.001-1.007）；<0.005）。早期急性呼吸衰竭与院内死亡率（3.172，95%置信区间 1.496-6.725；0.002）和短期死亡率（3.335（1.815-6.129）；0.0001）相关。
炎症反应与院外心脏骤停后早期急性呼吸衰竭显著相关。急性呼吸衰竭与院外心脏骤停后早期预后不良相关。
