传统心肺复苏与体外心肺复苏中的高氧血症与死亡率
Hyperoxia and mortality in conventional versus extracorporeal cardiopulmonary resuscitation.
作者信息
Stoll Sandra Emily, Paul Eldho, Pilcher David, Udy Andrew, Burrell Aidan
机构信息
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia; Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany.
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
出版信息
J Crit Care. 2022 Jun;69:154001. doi: 10.1016/j.jcrc.2022.154001. Epub 2022 Feb 23.
PURPOSE
Hyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. Study-objective was to examine the association between hyperoxia and 30-day mortality in a mixed cohort of two different modes of Cardiopulmonary Resuscitation (CPR): Extracorporeal (ECPR) vs. Conventional (CCPR).
MATERIAL AND METHODS
In this retrospective cohort study of CA patients admitted to a tertiary level CA centre in Australia (over a 6.5-year time period) mean arterial oxygen levels (PaO) and episodes of extreme hyperoxia (maximum of mean PaO ≥ 300 mmHg) were analysed over the first 8 days post CA.
RESULTS
One hundred and sixty-nine post CA patients were assessed (ECPR n = 79 / CCPR n = 90). Mean PaO-levels were higher in the ECPR vs CCPR group (211 mmHg ± 58.4 vs 119 mmHg ± 18.1; p < 0.0001) as was the proportion with at least one episode of extreme hyperoxia (74.7% vs 16.7%; p < 0.001). After adjusting for confounders and the mode of CPR any episode of extreme hyperoxia was independently associated with a 2.52-fold increased risk of 30-day mortality (OR: 2.52, 95% CI: 1.06-5.98; p = 0.036).
CONCLUSIONS
We found extreme hyperoxia was more common in ECPR patients in the first 8 days post CA and independently associated with higher 30-day mortality, irrespective of the CPR-mode.
目的
高氧血症与心脏骤停（CA）后患者的不良预后相关。本研究的目的是在两种不同心肺复苏（CPR）模式（体外膜肺氧合心肺复苏[ECPR]与传统心肺复苏[CCPR]）的混合队列中，研究高氧血症与30天死亡率之间的关联。
材料与方法
在这项对澳大利亚一家三级CA中心收治的CA患者进行的回顾性队列研究中（为期6.5年），分析了CA后前8天的平均动脉血氧水平（PaO）和极度高氧血症发作情况（平均PaO最大值≥300 mmHg）。
结果
共评估了169例CA后患者（ECPR组n = 79 / CCPR组n = 90）。ECPR组的平均PaO水平高于CCPR组（211 mmHg±58.4 vs 119 mmHg±18.1；p < 0.0001），至少有一次极度高氧血症发作的比例也是如此（74.7% vs 16.7%；p < 0.001）。在对混杂因素和CPR模式进行调整后，任何一次极度高氧血症发作都与30天死亡率增加2.52倍独立相关（OR：2.52，95% CI：1.06 - 5.98；p = 0.036）。
结论
我们发现，CA后前8天，极度高氧血症在ECPR患者中更为常见，且与30天死亡率较高独立相关，与CPR模式无关。
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