School of Medicine, College of Medicine, China Medical University.
Department of Emergency Medicine, China Medical University Hospital.
Medicine (Baltimore). 2021 Apr 30;100(17):e25724. doi: 10.1097/MD.0000000000025724.
Metabolic acidosis is observed in 98% of patients with out-of-hospital cardiac arrest (OHCA). The longer the no-flow or low-flow duration, the more severe is the acidosis in these patients. This study explored whether blood pH in early stages of advanced life support (ALS) was an independent predictor of neurological prognosis in patients with OHCA.We retrospectively enrolled patients with OHCA from January 2012 to June 2018 in a single-medical tertiary hospital in Taiwan. Patients with OHCA whose blood gas analyses within 5 minutes after receiving ALS at the emergency department (ED) were enrolled. Patients younger than 20 years old, with cardiac arrest resulting from traumatic or circumstantial causes, with return of spontaneous circulation (ROSC) before ED arrival, lacking record of initial blood gas analysis, and with do-not-resuscitate orders were excluded. The primary outcome of this study was neurological status at hospital discharge.In total, 2034 patients with OHCA were enrolled. The majority were male (61.89%), and the average age was 67.8 ± 17.0 years. Witnessed OHCA was noted in 571 cases, cardiopulmonary resuscitation was performed before paramedic arrival in 512 (25.2%) cases, and a shockable rhythm was observed in 269 (13.2%). Blood pH from initial blood gas analysis remained an independent predictor of neurological outcome after multivariate regression.Blood pH at early stages of ALS was an independent prognostic factor of post-OHCA neurological outcome. Blood gas analysis on arrival at the ED may provide additional information about the prognosis of patients with OHCA.
代谢性酸中毒可见于 98%的院外心脏骤停（OHCA）患者。无血流或低血流时间越长，这些患者的酸中毒越严重。本研究探讨了在高级生命支持（ALS）早期的血液 pH 是否为 OHCA 患者神经预后的独立预测因素。
我们回顾性纳入了 2012 年 1 月至 2018 年 6 月在台湾一家单一医学三级医院接受治疗的 OHCA 患者。纳入在急诊科（ED）接受 ALS 后 5 分钟内进行血气分析的 OHCA 患者。排除年龄小于 20 岁、因创伤或环境原因导致心脏骤停、ED 到达前自主循环恢复（ROSC）、初始血气分析记录缺失和有不复苏医嘱的患者。本研究的主要终点为出院时的神经状态。
共纳入 2034 例 OHCA 患者。大多数患者为男性（61.89%），平均年龄为 67.8±17.0 岁。571 例为目击性 OHCA，512 例（25.2%）在急救人员到达前进行心肺复苏，269 例（13.2%）观察到可除颤节律。多变量回归后，初始血气分析中的血液 pH 仍然是神经预后的独立预测因子。ALS 早期的血液 pH 是 OHCA 后神经预后的独立预测因素。ED 到达时的血气分析可能为 OHCA 患者的预后提供额外信息。
