碳酸氢钠在儿科心肺复苏中的应用：ICU-RESUScitation 项目试验的二次分析。
Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial.
机构信息
Department of Pediatrics, Duke Children's Hospital, Duke University, Durham, NC.
Department of Pediatrics, University of Utah, Salt Lake City, UT.
出版信息
Pediatr Crit Care Med. 2022 Oct 1;23(10):784-792. doi: 10.1097/PCC.0000000000003045. Epub 2022 Jul 26.
OBJECTIVES
To evaluate associations between sodium bicarbonate use and outcomes during pediatric in-hospital cardiac arrest (p-IHCA).
DESIGN
Prespecified secondary analysis of a prospective, multicenter cluster randomized interventional trial.
SETTING
Eighteen participating ICUs of the ICU-RESUScitation Project (NCT02837497).
PATIENTS
Children less than or equal to 18 years old and greater than or equal to 37 weeks post conceptual age who received chest compressions of any duration from October 2016 to March 2021.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Child and event characteristics, prearrest laboratory values (2-6 hr prior to p-IHCA), pre- and intraarrest hemodynamics, and outcomes were collected. In a propensity score weighted cohort, the relationships between sodium bicarbonate use and outcomes were assessed. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Of 1,100 index cardiopulmonary resuscitation events, median age was 0.63 years (interquartile range, 0.19-3.81 yr); 528 (48.0%) received sodium bicarbonate; 773 (70.3%) achieved ROSC; 642 (58.4%) survived to hospital discharge; and 596 (54.2%) survived to hospital discharge with favorable neurologic outcome. Among the weighted cohort, sodium bicarbonate use was associated with lower survival to hospital discharge rate (adjusted odds ratio [aOR], 0.7; 95% CI, 0.54-0.92; p = 0.01) and lower survival to hospital discharge with favorable neurologic outcome rate (aOR, 0.69; 95% CI, 0.53-0.91; p = 0.007). Sodium bicarbonate use was not associated with ROSC (aOR, 0.91; 95% CI, 0.62-1.34; p = 0.621).
CONCLUSIONS
In this propensity weighted multicenter cohort study of p-IHCA, sodium bicarbonate use was common and associated with lower rates of survival to hospital discharge.
目的
评估小儿院内心搏骤停（p-IHCA）期间使用碳酸氢钠与结局的关联。
设计
前瞻性、多中心集群随机干预试验的预设二次分析。
设置
ICU-RESCUSCITATION 项目的 18 个参与 ICU（NCT02837497）。
患者
年龄在 37 周胎龄以上至 18 岁以下且接受了任何持续时间的胸外按压的儿童。
干预措施
无。
测量和主要结果
收集了患儿和事件特征、逮捕前实验室值（在 p-IHCA 前 2-6 小时）、逮捕前和逮捕期间的血液动力学以及结局。在倾向评分加权队列中，评估了碳酸氢钠使用与结局的关系。主要结局是存活至出院。次要结局包括自主循环恢复（ROSC）和存活至出院并有良好神经结局。在 1100 例索引心肺复苏事件中，中位年龄为 0.63 岁（四分位距，0.19-3.81 岁）；528 例（48.0%）接受了碳酸氢钠；773 例（70.3%）实现了 ROSC；642 例（58.4%）存活至出院；596 例（54.2%）存活至出院并有良好神经结局。在加权队列中，碳酸氢钠的使用与较低的出院存活率相关（调整优势比 [aOR]，0.7；95%CI，0.54-0.92；p = 0.01）和较低的出院且具有良好神经结局的存活率相关（aOR，0.69；95%CI，0.53-0.91；p = 0.007）。碳酸氢钠的使用与 ROSC 无关（aOR，0.91；95%CI，0.62-1.34；p = 0.621）。
结论
在这项针对 p-IHCA 的倾向评分加权多中心队列研究中，碳酸氢钠的使用很常见，并且与较低的出院存活率相关。
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