Shiba Daiki, Hifumi Toru, Tsuchiya Makiko, Hattori Kenji, Kawakami Naoki, Shin Kijong, Fukazawa Nozomi, Horie Katsuhiro, Watanabe Yu, Ishikawa Yohei, Shimizu Masato, Isokawa Shutaro, Toya Nozomi, Iwasaki Tsutomu, Otani Norio, Ishimatsu Shinichi
Department of Emergency and Critical Care Medicine, St. Luke's International Hospital Tokyo Japan.
Circ Rep. 2019 Nov 20;1(12):575-581. doi: 10.1253/circrep.CR-19-0077.
We examined the association between initiation of extracorporeal cardiopulmonary resuscitation (ECPR) and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, after out-of-hospital cardiac arrest (OHCA) in patients who received targeted temperature management (TTM). This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who had been admitted to St. Luke's International Hospital between April 2006 and December 2018. The primary endpoint was the association between the type of CPR and the incidence of early onset pneumonia in the intensive care unit (ICU; between 48 h and 7 days of hospitalization). Univariate and multivariate logistic regression analyses were performed for the primary endpoints. After applying the inclusion/exclusion criteria, 254 patients were included in the analyses; of these, 52 were enrolled in the ECPR group, and 202 were enrolled in the CCPR group. Median age was 58 years, 88.5% were male, prophylactic antibiotics were used in 80.3%, and favorable neurological outcomes were observed in 51.9%. On multivariate analysis, ECPR (odds ratio [OR], 2.78; 95% CI: 1.16-6.66; P=0.037) was significantly associated with the development of early onset pneumonia. ECPR was an independent predictor of pneumonia after OHCA in patients who received TTM.
我们研究了在接受目标温度管理(TTM)的院外心脏骤停(OHCA)患者中,体外心肺复苏(ECPR)的启动与感染性并发症(如肺炎、脓毒症和菌血症)发生率之间的关联。这项回顾性研究使用了2006年4月至2018年12月期间入住圣卢克国际医院、接受TTM治疗的OHCA患者的医院病历数据。主要终点是心肺复苏类型与重症监护病房(ICU;住院48小时至7天之间)早发性肺炎发生率之间的关联。对主要终点进行单因素和多因素逻辑回归分析。应用纳入/排除标准后,254例患者纳入分析;其中,52例纳入ECPR组,202例纳入CCPR组。中位年龄为58岁,男性占88.5%,80.3%使用了预防性抗生素,51.9%观察到良好的神经学转归。多因素分析显示,ECPR(比值比[OR],2.78;95%CI:1.16 - 6.66;P = 0.037)与早发性肺炎的发生显著相关。在接受TTM的OHCA患者中,ECPR是肺炎的独立预测因素。