Departments of Emergency Medicine and Critical Care, University of Florida - Shands Hospital, Gainesville, Florida.
Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
J Emerg Med. 2020 Oct;59(4):e105-e111. doi: 10.1016/j.jemermed.2020.06.007. Epub 2020 Jul 16.
Sudden cardiac arrest is the most common cause of death worldwide, and prognostication after survival remains challenging. Decisions regarding prognosis can be fraught with error in the immediate postarrest period, with guidelines recommending the use of various tests, including blood gas pH, to determine which interventions to perform. Despite these recommendations, the prognostic utility of blood gas pH remains unclear.
In this retrospective cohort study, we aimed to demonstrate the prognostic utility of emergency department blood gas pH after return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest.
A retrospective cohort study was performed, including all adult survivors of out-of-hospital cardiac arrest (n = 79). Primary disease-oriented outcome was venous blood pH after ROSC and survival to hospital discharge.
In patients with out-of-hospital cardiac arrest, pH < 7.2 was associated with decreased likelihood of survival to hospital discharge (odds ratio 0.06), with every 0.1-unit increase in pH being associated with an increased likelihood of survival (1.98). Based on the area under the receiver curve, the pH that optimizes sensitivity and specificity for predicting survival was 7.04.
Both presence and degree of acidemia on initial blood gas after ROSC was associated with a decreased likelihood of survival to hospital discharge. The optimal cutoff for prediction in this cohort of patients was 7.04. Using a higher pH cutoff would result in fewer patients receiving intervention that would otherwise have survived.
心脏骤停是全球最常见的死亡原因，复苏后预后仍然具有挑战性。在心脏骤停后即刻，预后决策可能存在错误，指南建议使用包括血气 pH 值在内的各种测试来确定进行哪些干预。尽管有这些建议，但血气 pH 值的预后价值仍不清楚。
在这项回顾性队列研究中，我们旨在证明在院外心脏骤停患者自主循环恢复（ROSC）后，急诊血气 pH 值的预后价值。
进行了一项回顾性队列研究，纳入了所有院外心脏骤停的成年幸存者（n=79）。主要以疾病为导向的预后终点为 ROSC 后的静脉血 pH 值和存活至出院。
在院外心脏骤停患者中，pH 值<7.2 与存活至出院的可能性降低相关（优势比 0.06），每增加 0.1 单位 pH 值与存活的可能性增加相关（1.98）。基于接受者操作特征曲线下的面积，优化预测存活的 pH 值为 7.04。
ROSC 后初始血气中存在酸中毒和酸中毒程度与存活至出院的可能性降低相关。在该患者队列中，预测的最佳截断值为 7.04。使用更高的 pH 值截断值将导致更少的患者接受干预，否则这些患者将存活。
