Kim June-Sung, Kim Youn-Jung, Kim Muyeol, Ryoo Seung Mok, Sohn Chang Hwan, Ahn Shin, Kim Won Young
Department of Emergency Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Ther Hypothermia Temp Manag. 2021 Jun;11(2):96-102. doi: 10.1089/ther.2019.0047. Epub 2020 May 22.
The aim of this study was to evaluate the incidence and determinants of acute respiratory distress syndrome (ARDS) after cardiac arrest (CA). We conducted an observational, retrospective cohort study with consecutive adult out-of-hospital and in-hospital (occurred only in the emergency department, ED) CA survivors from our ED. Development of ARDS was identified by results of arterial blood gases, chest images, and transthoracic echocardiography according to the Berlin definition. The primary outcome was the poor neurologic outcome, defined as cerebral performance category ≥3 at 28 days, and secondary outcomes were 28-day mortality, recovery rate from ARDS, duration of mechanical ventilator use, and length of stay. Among 295 enrolled patients, 30 patients who received extracorporeal membrane oxygenation and 19 patents who had cardiogenic pulmonary edema were excluded. ARDS had developed in 119 (48.4%) patients on admission (mild 20 [16.8%], moderate 48 [40.3%], and severe 51 [42.9%]) and 54 (45.4%) patients recovered before hospital discharge. Development of ARDS was associated with poor neurologic outcomes at 28 days (adjusted hazard ratio (HR) 1.44 [95% confidence interval (CI): 1.05-1.98]). Moreover, more severe ARDS was associated with a higher risk of poor neurological outcomes (mild: reference; moderate: adjusted HR 1.66 [95% CI: 1.10-2.49]; and severe: adjusted HR 1.76 [95% CI: 1.16-2.65]). Therefore, development of ARDS after CA was associated with unfavorable neurologic outcomes and had a linear association with ARDS severity. Early recognition and proper management of ARDS may be useful during post-CA care.
本研究旨在评估心脏骤停（CA）后急性呼吸窘迫综合征（ARDS）的发生率及相关因素。我们进行了一项观察性回顾性队列研究，纳入了我院急诊科连续的成年院外及院内（仅发生于急诊科）CA幸存者。根据柏林定义，通过动脉血气结果、胸部影像及经胸超声心动图来确定ARDS的发生情况。主要结局为神经功能预后不良，定义为28天时脑功能分类≥3级；次要结局包括28天死亡率、ARDS恢复率、机械通气使用时长及住院时间。在295例入组患者中，排除了30例接受体外膜肺氧合治疗的患者及19例有心源性肺水肿的患者。119例（48.4%）患者入院时已发生ARDS（轻度20例[16.8%]，中度48例[40.3%]，重度51例[42.9%]），54例（45.4%）患者在出院前恢复。ARDS的发生与28天时神经功能预后不良相关（校正风险比[HR] 1.44 [95%置信区间[CI]：1.05 - 1.98]）。此外，更严重的ARDS与神经功能预后不良风险更高相关（轻度：参照组；中度：校正HR 1.66 [95% CI：1.10 - 2.49]；重度：校正HR 1.76 [95% CI：1.16 - 2.65]）。因此，CA后ARDS的发生与不良神经功能预后相关，且与ARDS严重程度呈线性相关。在CA后护理期间，早期识别并妥善处理ARDS可能有益。
