Akasaka Toshihiko, Watanabe Tomomi, Mukai-Yatagai Natsuko, Sasaki Naoko, Furuse Yoshiyuki, Shirota Kinya, Kato Masahiko, Yamamoto Kazuhiro
Department of Molecular Medicine and Therapeutics, Faculty of Medicine Tottori University.
Department of Cardiology, Matsue Red Cross Hospital.
Int Heart J. 2020 Mar 28;61(2):295-300. doi: 10.1536/ihj.19-406. Epub 2020 Mar 14.
Many patients are transferred to hospital due to out-of-hospital cardiac arrest (OHCA), and, unfortunately, most suffer from cerebral damage. Currently, it is difficult to predict the recovery of neurological function after return of spontaneous circulation (ROSC) in the acute phase. Increased intracellular Ca induces cell death in the acute phase. Accordingly, we predicted that serum adjusted Ca will decrease following Ca influx into cells. Consequently, serum adjusted Ca in the acute phase may be able to predict recovery of neurological function in patients with ROSC from OHCA. This is a retrospective and observational study from 2 centers. A total of 190 consecutive patients with ROSC from OHCA were recruited, with 33 patients meeting the inclusion criteria. The relationship between serum adjusted Ca within 48 hours after ROSC and neurological function at discharge (as evaluated by the Glasgow-Pittsburgh cerebral performance category) was examined. Serum adjusted Ca was measured every 4 hours within a 48-hour period after ROSC. There were no significant differences in hemodynamical state and laboratory data between the 2 groups. However, lowest serum adjusted Ca within 48 hours after ROSC was significantly lower in the poor neurological outcome group (0.96 ± 0.06 versus 1.02 ± 0.06 mmol/L, P = 0.011). Thus, lowest serum adjusted Ca within 48 hours after ROSC may be a predictive factor for recovery of neurological function at discharge in patients with ROSC from OHCA.
许多患者因院外心脏骤停（OHCA）被转运至医院，不幸的是，大多数患者都遭受脑损伤。目前，在急性期很难预测自主循环恢复（ROSC）后神经功能的恢复情况。细胞内钙增加会在急性期导致细胞死亡。因此，我们推测随着钙流入细胞，血清校正钙会降低。因此，急性期的血清校正钙可能能够预测OHCA后发生ROSC患者的神经功能恢复情况。这是一项来自2个中心的回顾性观察研究。共招募了190例连续的OHCA后发生ROSC的患者，其中33例符合纳入标准。研究了ROSC后48小时内血清校正钙与出院时神经功能（通过格拉斯哥-匹兹堡脑功能分类评估）之间的关系。在ROSC后的48小时内，每4小时测量一次血清校正钙。两组之间的血流动力学状态和实验室数据无显著差异。然而，神经功能预后不良组ROSC后48小时内的最低血清校正钙显著更低（0.96±0.06对1.02±0.06 mmol/L，P = 0.011）。因此，ROSC后48小时内的最低血清校正钙可能是OHCA后发生ROSC患者出院时神经功能恢复的一个预测因素。
