Chiba Takuyo, Otaka Shunichi, Igeta Ryuhei, Burns Michele M, Ikeda Shunya, Shiga Takashi
Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan.
Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan.
Resuscitation. 2022 Nov;180:52-58. doi: 10.1016/j.resuscitation.2022.09.009. Epub 2022 Sep 19.
Poisoning is an important cause of out-of-hospital cardiac arrest which can be challenging to manage. Neurological outcomes after poisoning-induced out-of-hospital cardiac arrest (POHCA) are yet to be fully elucidated. This retrospective cohort study sought to describe the characteristics of POHCA, and identify factors associated with favourable neurologic outcomes.
Cardiac arrests recorded in the "All Japan Utstein Registry" from 1 January 2012 to 31 December 2017 were included. A descriptive analysis of the characteristics of POHCA and non-POHCA patients was performed. Neurological outcomes were compared between the POHCA and non-POHCA groups using logistic regression analysis. Subgroup analysis was performed for patients who underwent prolonged resuscitation.
Compared to non-POHCA patients (n = 665,262), POHCA patients (n = 1,868) were younger (median age, 80 vs 51 years) and had a lower likelihood of having a witness, bystander cardiopulmonary resuscitation, and an initial shockable rhythm. Multivariable logistic regression analysis showed that POHCA was associated with favourable neurologic outcomes (odds ratio 1.54, 95 % confidence interval 1.19-2.01, p = 0.001). Among patients who received > 30 min of resuscitation, neurologic outcomes were similar in those with POHCA and non-POHCA (favourable neurologic outcome, 1.03 % vs 0.98 %, p = 0.87).
POHCA is associated with favourable neurological outcomes and requires aggressive resuscitation. However, in patients who required prolonged resuscitation, the outcomes of POHCA were not different from those of non-POHCA. The decision to perform prolonged resuscitation should be guided on a case-by-case basis based on a range of factors.
中毒是院外心脏骤停的一个重要原因，其处理可能具有挑战性。中毒所致院外心脏骤停（POHCA）后的神经学转归尚未完全阐明。这项回顾性队列研究旨在描述POHCA的特征，并确定与良好神经学转归相关的因素。
纳入2012年1月1日至2017年12月31日在“全日本乌斯坦登记处”记录的心脏骤停病例。对POHCA和非POHCA患者的特征进行描述性分析。使用逻辑回归分析比较POHCA组和非POHCA组的神经学转归。对接受长时间复苏的患者进行亚组分析。
与非POHCA患者（n = 665,262）相比，POHCA患者（n = 1,868）更年轻（中位年龄，80岁对51岁），有目击者、旁观者进行心肺复苏以及初始可电击心律的可能性更低。多变量逻辑回归分析显示，POHCA与良好的神经学转归相关（比值比1.54，95%置信区间1.19 - 2.01，p = 0.001）。在接受>30分钟复苏的患者中，POHCA患者和非POHCA患者的神经学转归相似（良好神经学转归，1.03%对0.98%，p = 0.87）。
POHCA与良好的神经学转归相关，需要积极复苏。然而，在需要长时间复苏的患者中，POHCA的转归与非POHCA的转归没有差异。进行长时间复苏的决定应根据一系列因素逐案指导。
