Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal.
Rev Port Cardiol (Engl Ed). 2021 May;40(5):317-325. doi: 10.1016/j.repce.2020.07.017.
Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis.
To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes.
We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed.
A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome.
This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
成功从心脏骤停 (CA) 中复苏的患者被收入重症监护病房 (ICU) 进行复苏后护理。这些患者的预后仍然不佳，只有少数患者能够存活至出院。了解这些患者管理中涉及的临床因素对于改善其预后至关重要。
描述从 CA 成功复苏后入院的人群，并分析与他们结局相关的因素。
我们对 2014 年 1 月至 2018 年 12 月五年间 ICU 收治的 CA 后患者进行了回顾性描述性研究。分析了人口统计学因素、CA 特征、早期管理、死亡率和神经学结局。
共收治了 187 名患者，中位年龄为 67 岁，其中 39%为院外 CA；87%为初始非电击性节律，最常见的假定原因为心脏性（31%）。院内死亡率为 63%。出院时存活患者中 31%存在显著神经功能障碍（脑功能状态分类 3 或 4 级）。非即时开始基础生命支持 (BLS)、更高的简化急性生理学评分 II 评分和更长的血管加压素支持相对持续时间是院内死亡率的独立预测因素，而可电击节律与生存率提高相关。入住 ICU 时格拉斯哥昏迷量表评分较高和 ICU 住院时间较短是神经学结局较好的预测因素。
本研究强调了可电击节律的积极预后影响，并证实了即时开始 BLS 和迅速除颤的重要性，支持了在医院内外进行更好培训的必要性。
