Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Crit Care Med. 2022 Feb 1;50(2):235-244. doi: 10.1097/CCM.0000000000005274.
We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings.
Retrospective analysis of the Korean Hypothermia Network Pro registry.
Multicenter ICU.
Adult (≥ 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33-36°C between October 2015 and December 2018.
None.
We measured the time from the end of rewarming to awakening, defined as a total Glasgow Coma Scale score greater than or equal to 9 or Glasgow Coma Scale motor score equals to 6. The primary outcome was awakening time. The secondary outcome was 6-month neurologic outcomes (poor outcome: Cerebral Performance Category 3-5). Among 1,145 out-of-hospital cardiac arrest survivors, 477 patients (41.7%) regained consciousness 30 hours (6-71 hr) later, and 116 patients (24.3%) awakened late (72 hr after the end of rewarming). Young age, witnessed arrest, shockable rhythm, cardiac etiology, shorter time to return of spontaneous circulation, lower serum lactate level, absence of seizures, and multisedative requirement were associated with awakening. Of the 477 who woke up, 74 (15.5%) had poor neurologic outcomes. Older age, liver cirrhosis, nonshockable rhythm, noncardiac etiology, a higher Sequential Organ Failure Assessment score, and higher serum lactate levels were associated with poor neurologic outcomes. Late awakeners were more common in the poor than in the good neurologic outcome group (38/74 [51.4%] vs 78/403 [19.4%]; p < 0.001). The awakening time (odds ratio, 1.005; 95% CIs, 1.003-1.008) and late awakening (odds ratio, 3.194; 95% CIs, 1.776-5.746) were independently associated with poor neurologic outcomes.
Late awakening after out-of-hospital cardiac arrest was common in no withdrawal of life-sustaining therapy settings and the probability of awakening decreased over time.
本研究旨在探究在未撤生命支持治疗的情况下，院外心脏骤停幸存者的觉醒时间和觉醒特征，以及与不良神经结局相关的因素。
韩国低温网络注册研究的回顾性分析。
多中心 ICU。
2015 年 10 月至 2018 年 12 月期间，在 33-36°C 下接受目标温度管理的，处于昏迷状态的成年（≥18 岁）院外心脏骤停幸存者。
无。
我们测量了从复温结束到觉醒的时间，定义为格拉斯哥昏迷量表评分总和≥9 或格拉斯哥昏迷量表运动评分等于 6。主要结局为觉醒时间。次要结局为 6 个月时的神经结局（不良结局：脑功能预后分类 3-5 级）。在 1145 例院外心脏骤停幸存者中，477 例（41.7%）在 30 小时（6-71 小时）后恢复意识，116 例（24.3%）觉醒延迟（复温结束后 72 小时）。年龄较小、目击者见证、可除颤节律、心源性病因、自主循环恢复时间较短、血清乳酸水平较低、无癫痫发作和多镇静剂需求与觉醒有关。在 477 例苏醒的患者中，74 例（15.5%）神经结局不良。年龄较大、肝硬化、非可除颤节律、非心源性病因、序贯器官衰竭评估评分较高和较高的血清乳酸水平与不良神经结局相关。不良神经结局组中晚期觉醒者更为常见（38/74[51.4%]比 78/403[19.4%]；p<0.001）。觉醒时间（优势比，1.005；95%可信区间，1.003-1.008）和晚期觉醒（优势比，3.194；95%可信区间，1.776-5.746）与不良神经结局独立相关。
在未撤生命支持治疗的情况下，院外心脏骤停后晚期觉醒较为常见，且随着时间的推移，觉醒的可能性逐渐降低。
