Peluso Lorenzo, Belloni Ilaria, Calabró Lorenzo, Dell'Anna Antonio Maria, Nobile Leda, Creteur Jacques, Vincent Jean-Louis, Taccone Fabio Silvio
Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
Resuscitation. 2020 May;150:1-7. doi: 10.1016/j.resuscitation.2020.02.030. Epub 2020 Mar 10.
The relationship of PaO and PaCO levels with outcome after cardiac arrest (CA) is controversial. Few studies have analysed both PaO and PaCO in this setting and the overall exposure to different PaO and PaCO levels has not been taken into account.
We reviewed blood gas data obtained within the first 24 h from all comatose adult patients who were admitted to the intensive care unit after successful resuscitation from CA. Exposure times to different PaO and PaCO thresholds were reported as areas under the curve (AUC) and the time above these thresholds was then calculated. The primary outcome measure was neurological outcome assessed using the Cerebral Performance Category (CPC) score at 3 months. An unfavourable outcome was defined as a CPC of 3-5 and a favourable outcome as a CPC of 1-2.
A total of 356 patients were studied, with a median number of 9 [6-11] blood gas measurements within the first 24 h after admission. The highest and lowest PaO and PaCO were similar in patients with unfavourable and favourable neurological outcomes. There were no differences in the AUCs or times over different thresholds of PaO and PaCO in the two groups. In a multivariable analysis, high blood lactate concentrations on admission, presence of shock and a non-shockable initial rhythm were significantly associated with unfavourable outcome.
There was no association between exposure to various levels of PaO and PaCO and neurological outcome after cardiac arrest.
心脏骤停（CA）后动脉血氧分压（PaO）和动脉血二氧化碳分压（PaCO）水平与预后的关系存在争议。很少有研究在这种情况下同时分析PaO和PaCO，并且尚未考虑不同PaO和PaCO水平的总体暴露情况。
我们回顾了所有在CA成功复苏后入住重症监护病房的昏迷成年患者在入院后24小时内获得的血气数据。将不同PaO和PaCO阈值的暴露时间报告为曲线下面积（AUC），然后计算高于这些阈值的时间。主要结局指标是在3个月时使用脑功能分类（CPC）评分评估的神经功能结局。不良结局定义为CPC评分为3-5，良好结局定义为CPC评分为1-2。
共研究了356例患者，入院后24小时内血气测量中位数为9次[6-11次]。神经功能结局不良和良好的患者中，最高和最低的PaO和PaCO相似。两组在不同PaO和PaCO阈值的AUC或持续时间上没有差异。在多变量分析中，入院时高血乳酸浓度、休克的存在和不可电击的初始心律与不良结局显著相关。
心脏骤停后暴露于不同水平的PaO和PaCO与神经功能结局之间没有关联。
