Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Am J Emerg Med. 2022 Nov;61:74-80. doi: 10.1016/j.ajem.2022.08.035. Epub 2022 Aug 21.
Anaphylaxis is a potentially life-threatening condition that occurs in the emergency department (ED). Although anaphylaxis is rapidly recognized and treated in the hospital compared with that in the community, in some cases, it does not respond to proper management.
The aim of this study is to describe our experience of cases of refractory anaphylaxis leading to cardiac arrest in hospital, to review their characteristics compared with those seen in the community, and to discuss the best management practices for anaphylaxis-induced cardiac arrest with a literature review.
We reviewed the medical records of patients referred to the ED with possible in-hospital anaphylaxis between January 2017 and May 2021. According to the anaphylaxis protocol, epinephrine, corticosteroid, and antihistamine were administered immediately on-site at our institution before the study period. Refractory anaphylaxis was defined as the development of anaphylaxis-induced cardiac arrest even after following the anaphylaxis protocol.
A total of 246 cases were evaluated for possible anaphylaxis, with 236 cases meeting the criteria for a diagnosis of anaphylaxis. Among them, 178 patients showed the signs and symptoms of shock, and cardiac arrest occurred in 6 patients (2.5%). Of the six patients, three had a return of spontaneous circulation before admission to the ED, while two died due to refractory cardiac arrest despite resuscitation in the ED. Following post-cardiac arrest care, including temperature management, one patient who received extracorporeal cardiopulmonary resuscitation survived neurologically intact.
We present our case series to highlight the risk of developing refractory anaphylaxis with subsequent in-hospital cardiac arrest. Patients may progress to cardiac arrest within minutes despite prompt recognition and management. If patients present with potentially fatal symptoms, a more aggressive approach, including intravenous adrenaline infusion, should be taken.
过敏反应是一种潜在的危及生命的疾病，发生在急诊科（ED）。虽然与社区相比，医院对过敏反应的识别和治疗更为迅速，但在某些情况下，它并不能对适当的治疗产生反应。
本研究旨在描述我们在医院中遇到的导致心搏骤停的难治性过敏反应病例的经验，比较其与社区中所见病例的特征，并通过文献复习讨论治疗过敏反应引起的心搏骤停的最佳管理实践。
我们回顾了 2017 年 1 月至 2021 年 5 月期间因可能在院过敏反应而被转至急诊科的患者的病历。在研究期间之前，根据过敏反应方案，在我院现场立即给予肾上腺素、皮质类固醇和抗组胺药。难治性过敏反应定义为即使遵循过敏反应方案，仍发生过敏反应引起的心搏骤停。
共评估了 246 例可能的过敏反应病例，其中 236 例符合过敏反应的诊断标准。在这 236 例中，有 178 例患者出现休克迹象和症状，6 例患者（2.5%）发生心搏骤停。在这 6 例患者中，有 3 例在转入急诊科前恢复了自主循环，而有 2 例尽管在急诊科进行了复苏，但由于难治性心搏骤停而死亡。在接受心搏骤停后护理，包括体温管理后，1 例接受体外心肺复苏的患者存活且神经功能完整。
我们提出了我们的病例系列，以强调在院内发生难治性过敏反应并随后发生心搏骤停的风险。尽管迅速识别和治疗，患者可能在数分钟内进展为心搏骤停。如果患者出现潜在致命症状，应采取更积极的治疗方法，包括静脉内肾上腺素输注。
