目标温度管理和紧急冠状动脉血管造影与院前自主循环恢复患者的转归改善相关。
Targeted temperature management and emergent coronary angiography are associated with improved outcomes in patients with prehospital return of spontaneous circulation.
机构信息
Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2020 Aug;119(8):1259-1266. doi: 10.1016/j.jfma.2020.03.017. Epub 2020 Apr 13.
BACKGROUND/PURPOSE: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown.
METHODS
This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrest patients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge.
RESULTS
Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1-2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3-5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296-165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963-21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075-19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764-120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004-236.836, p = 0.011).
CONCLUSION
In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.
背景/目的：在院前自主循环恢复（ROSC）的患者中，目标温度管理（TTM）和紧急冠状动脉血管造影（CAG）是否仍与更好的结果相关尚不清楚。
方法
这项回顾性队列研究纳入了 81 名患有非外伤性院外心脏骤停且具有良好的院前神经功能且在 2012 年至 2017 年 8 月期间实现了院前 ROSC 的成年患者。结局是出院时的存活和出院时的神经恢复。
结果
55 名患者（67.9%）存活至出院（幸存者组），26 名（32.1%）死亡（非幸存者组）。共有 47 名患者（58.0%）出现良好的神经结局[脑功能分类（CPC）评分=1-2，良好组]，34 名患者（42.0%）出现不良神经结局（CPC 评分=3-5，不良组）。幸存者组 TTM（45.5%比 19.2%，p=0.023）和紧急 CAG（76.4%比 19.2%，p<0.001）的患者比例高于非幸存者组，且在神经结局方面也存在相似的发现（TTM：44.7%比 26.5%，p=0.094；CAG：80.9%比 26.5%，p<0.001）。TTM 与存活率增加相关[比值比（OR）=14.635，95%置信区间（CI）=1.296-165.305，p=0.030]，并且与良好的神经恢复呈趋势相关（OR=4.551，95%CI=0.963-21.517，p=0.056）。排除 ROSC 后神经快速恢复的患者（n=70）后，TTM 与良好的神经结局相关（OR=4.534，95%CI=1.075-19.127，p=0.040）。紧急 CAG 与存活率相关（OR=9.599，95%CI=0.764-120.634，p=0.080），与良好的神经结局显著相关（OR=21.785，95%CI=2.004-236.836，p=0.011）。
结论
在院前 ROSC 的患者中，TTM 和紧急 CAG 均与存活率和神经结局的改善相关。
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