Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Resuscitation. 2021 Dec;169:11-19. doi: 10.1016/j.resuscitation.2021.10.004. Epub 2021 Oct 11.
The importance of high-quality post-cardiac arrest care is well-described in adult and paediatric populations, but data are lacking to inform post-cardiac arrest care in the neonatal intensive care unit (NICU). The objective of this study was to describe post-cardiac arrest physiology and management in a quaternary NICU.
Retrospective descriptive study of post-cardiac arrest physiology and management. Data were abstracted from electronic medical records and an institutional resuscitation database. A cardiac arrest was defined as ≥1 minute of chest compressions. Only index arrests were analysed. Descriptive statistics were used to report patient, intra-arrest, and post-arrest characteristics.
There were 110 index cardiac arrests during the 5-year study period from 1/2017-2/2021. The majority (69%) were acute respiratory compromise leading to cardiopulmonary arrest (ARC-CPA) and 26% were primary cardiopulmonary arrests (CPA). Vital sign monitoring within 24 hours post-arrest was variable, especially non-invasive blood pressure frequency (median 5, range 1-44 measurements). There was a high prevalence of hypothermia (73% of arrest survivors). There was substantial variability in laboratory frequency within 24 hours post-arrest. Patients with primary CPA received significantly more lab testing and had a higher prevalence of acidosis (pH < 7.2) than those with ARC-CPA.
We identified significant variation in post-arrest management and a high prevalence of hypothermia. These data highlight the need for post-arrest management guidelines specific to neonatal physiology, as well as opportunities for quality improvement initiatives. Further research is needed to ascertain the impact of neonatal post-arrest management on long-term outcomes and survival.
高质量的心脏骤停后护理的重要性在成人和儿科人群中得到了很好的描述，但缺乏数据来为新生儿重症监护病房（NICU）的心脏骤停后护理提供信息。本研究的目的是描述四级 NICU 中的心脏骤停后生理学和管理情况。
对心脏骤停后生理学和管理情况进行回顾性描述性研究。数据从电子病历和机构复苏数据库中提取。心脏骤停定义为≥1 分钟的胸外按压。仅分析了指数性心脏骤停。使用描述性统计来报告患者、心脏骤停期间和心脏骤停后的特征。
在 2017 年 1 月至 2021 年 2 月的 5 年研究期间，发生了 110 次指数性心脏骤停。大多数（69%）是急性呼吸窘迫导致心肺骤停（ARC-CPA），26%是原发性心肺骤停（CPA）。心脏骤停后 24 小时内的生命体征监测存在差异，尤其是非侵入性血压监测的频率（中位数 5，范围 1-44 次测量）。低体温的发生率很高（73%的心脏骤停幸存者）。心脏骤停后 24 小时内实验室检测的频率存在很大差异。与 ARC-CPA 患者相比，原发性 CPA 患者接受了更多的实验室检测，酸中毒（pH 值<7.2）的发生率更高。
我们发现心脏骤停后管理存在显著差异，低体温的发生率很高。这些数据突出了制定针对新生儿生理学的心脏骤停后管理指南的必要性，以及进行质量改进举措的机会。需要进一步研究以确定新生儿心脏骤停后管理对长期结局和生存率的影响。
