Chi Chien-Yu, Tsai Min-Shan, Kuo Li-Kuo, Hsu Hsin-Hui, Huang Wei-Chun, Lai Chih-Hung, Chang Herman Chih-Heng, Tsai Chu-Lin, Huang Chien-Hua
Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan.
J Intensive Care. 2022 Aug 6;10(1):39. doi: 10.1186/s40560-022-00631-6.
Post-resuscitation hemodynamic level is associated with outcomes. This study was conducted to investigate if post-resuscitation diastolic blood pressure (DBP) is a favorable prognostic factor.
Using TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry, we recruited adult patients who received targeted temperature management in nine medical centers between January 2014 and September 2019. After excluding patients with extracorporeal circulation support, 448 patients were analyzed. The first measured, single-point blood pressure after resuscitation was used for analysis. Study endpoints were survival to discharge and discharge with favorable neurologic outcomes (CPC 1-2). Multivariate analysis, area under the receiver operating characteristic curve (AUC), and generalized additive model (GAM) were used for analysis.
Among the 448 patients, 182 (40.7%) patients survived, and 89 (19.9%) patients had CPC 1-2. In the multivariate analysis, DBP > 70 mmHg was an independent factor for survival (adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI, 1.41-3.31]) and > 80 mmHg was an independent factor for CPC 1-2 (aOR 2.04, 95% CI [1.14-3.66]). GAM confirmed that DBP > 80 mmHg was associated with a higher likelihood of CPC 1-2. In the exploratory analysis, patients with DBP > 80 mmHg had a significantly higher prevalence of cardiogenic cardiac arrest (p = 0.015) and initial shockable rhythm (p = 0.045).
We found that DBP after resuscitation can predict outcomes, as a higher DBP level correlated with cardiogenic cardiac arrest.
复苏后血流动力学水平与预后相关。本研究旨在调查复苏后舒张压（DBP）是否为一个有利的预后因素。
利用台湾心脏骤停目标温度管理网络（TIMECARD）登记系统，我们招募了2014年1月至2019年9月期间在9个医疗中心接受目标温度管理的成年患者。排除接受体外循环支持的患者后，对448例患者进行分析。复苏后首次测量的单点血压用于分析。研究终点为出院存活和出院时具有良好神经功能预后（脑功能分类[CPC]1 - 2级）。采用多变量分析、受试者操作特征曲线下面积（AUC）和广义相加模型（GAM）进行分析。
在448例患者中，182例（40.7%）存活，89例（19.9%）CPC为1 - 2级。在多变量分析中，DBP > 70 mmHg是存活的独立因素（校正比值比[aOR] 2.16，95%置信区间[CI，1.41 - 3.31]），DBP > 80 mmHg是CPC 1 - 2级的独立因素（aOR 2.04，95% CI [1.14 - 3.66]）。GAM证实DBP > 80 mmHg与CPC 1 - 2级的可能性更高相关。在探索性分析中，DBP > 80 mmHg的患者心源性心脏骤停的患病率显著更高（p = 0.015），初始可电击心律的患病率显著更高（p = 0.045）。
我们发现复苏后的DBP可以预测预后，因为较高的DBP水平与心源性心脏骤停相关。
