Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan.
Preventive Services, School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan; Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
Am J Emerg Med. 2021 Feb;40:89-95. doi: 10.1016/j.ajem.2020.12.032. Epub 2020 Dec 17.
Pediatric out-of-hospital cardiac arrest (OHCA) is one of the most critical conditions seen in the emergency department (ED). Although initial serum pH value is reported to be associated with outcome in adult OHCA patients, the association is unclear in pediatric OHCA patients. Thus, we aimed to identify the association between initial pH value and outcome among pediatric OHCA patients.
This study was a retrospective analysis of a multicenter prospective cohort registry (Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry) from 87 hospitals in Japan. We included pediatric OHCA patients younger than 16 years of age who were registered in this registry between June 2014 and December 2017. Of the 34,754 patients in the database, 458 patients were ultimately included in the analysis. We equally divided the patients into four groups, based on their initial pH value, and conducted a multivariate logistic regression analysis to calculate the adjusted odds ratios of the initial pH value on hospital arrival with their 95% confidence intervals for the primary outcome.
The median (interquartile range) age was 1 (0-6) year, and 77.9% (357/458) of the first monitored rhythm was asystole. The primary outcome was 1-month survival. The overall 1-month survival was 13.3% (61/458), and a 1-month favorable neurologic outcome was seen in 5.2% (24/458) of cases. The adjusted odds ratios and 95% confidence intervals for the pH 6.81-6.64, pH 6.63-6.47, pH <6.47, and pH unknown groups compared with the pH ≥6.82 group for 1-month survival were 0.39 (0.16-0.97), 0.13 (0.04-0.44), 0.03 (0.00-0.24), and 0.07 (0.02-0.21), respectively.
This study demonstrated the association between the initial pH value on hospital arrival and 1-month survival among pediatric OHCA patients.
儿科院外心脏骤停（OHCA）是急诊科最危急的病症之一。尽管初始血清 pH 值与成人 OHCA 患者的预后相关，但在儿科 OHCA 患者中，这种关联尚不清楚。因此，我们旨在确定儿科 OHCA 患者初始 pH 值与预后之间的关系。
本研究是对日本 87 家医院的多中心前瞻性队列登记处（日本急救医学协会院外心脏骤停登记处）的回顾性分析。我们纳入了该登记处 2014 年 6 月至 2017 年 12 月期间登记的年龄小于 16 岁的儿科 OHCA 患者。在数据库的 34754 名患者中，最终有 458 名患者纳入分析。我们根据初始 pH 值将患者分为四组，并进行多变量逻辑回归分析，以计算初始 pH 值与主要结局的医院到达时调整后的优势比及其 95%置信区间。
中位（四分位距）年龄为 1（0-6）岁，77.9%（357/458）的首次监测节律为心搏停止。主要结局为 1 个月生存率。总体 1 个月生存率为 13.3%（61/458），1 个月时神经系统预后良好的比例为 5.2%（24/458）。与 pH 值≥6.82 组相比，pH 值为 6.81-6.64、6.63-6.47、<6.47 和未知 pH 值组的 1 个月生存率的调整优势比及其 95%置信区间分别为 0.39（0.16-0.97）、0.13（0.04-0.44）、0.03（0.00-0.24）和 0.07（0.02-0.21）。
本研究表明，儿科 OHCA 患者入院时的初始 pH 值与 1 个月生存率之间存在关联。
