Zhou Dawei, Lv Yi, Lin Qing, Wang Chao, Fei Shuyang, He Wei
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Am J Emerg Med. 2023 Mar;65:139-145. doi: 10.1016/j.ajem.2023.01.004. Epub 2023 Jan 5.
Normocapnia is suggested for post resuscitation care. For patients with hypercapnia after cardiac arrest, the relationship between rate of change in partial pressure of carbon dioxide (PaCO) and functional outcome was unknown.
This was the secondary analysis of Resuscitation Outcomes Consortium (ROC) amiodarone, lidocaine, and placebo (ALPS) trial. Patients with at least 2 PaCO recorded and the first indicating hypercapnia (PaCO > 45 mmHg) after return of spontaneous circulation (ROSC) were included. The rate of change in PaCO was calculated as the ratio of the difference between the second and first PaCO to the time interval. The primary outcome was modified Rankin Score (mRS), dichotomized to good (mRS 0-3) and poor (mRS 4-6) outcomes at hospital discharge. The independent relationship between rate of change in PaCO and outcome was investigated with multivariable logistic regression model.
A total of 746 patients with hypercapnia were included for analysis, of which 264 (35.4%) patients had good functional outcome. The median rate of change in PaCO was 4.7 (interquartile range [IQR] 1.7-12) mmHg per hour. After adjusting for confounders, the rate of change in PaCO (odds ratio [OR] 0.994, confidence interval [CI] 0.985-1.004, p = 0.230) was not associated the functional outcome. However, rate of change in PaCO (OR 1.010, CI 1.001-1.019, p = 0.029) was independently associated with hospital mortality.
For OHCA patients with hypercapnia on admission, the rate of change in PaCO was not independently associated with functional outcome; however, there was a significant trend that higher decreased rate was associated with increased hospital mortality.
建议在心肺复苏后护理中维持正常碳酸血症。对于心脏骤停后出现高碳酸血症的患者，二氧化碳分压（PaCO₂）变化率与功能预后之间的关系尚不清楚。
这是复苏结果联盟（ROC）胺碘酮、利多卡因和安慰剂（ALPS）试验的二次分析。纳入至少记录了2次PaCO₂且首次显示自主循环恢复（ROSC）后出现高碳酸血症（PaCO₂>45 mmHg）的患者。PaCO₂变化率计算为第二次与第一次PaCO₂差值与时间间隔的比值。主要结局是改良Rankin量表（mRS），在出院时分为良好（mRS 0 - 3）和不良（mRS 4 - 6）结局。使用多变量逻辑回归模型研究PaCO₂变化率与结局之间的独立关系。
共纳入746例高碳酸血症患者进行分析，其中264例（35.4%）患者功能预后良好。PaCO₂的中位变化率为每小时4.7（四分位间距[IQR] 1.7 - 12）mmHg。在调整混杂因素后，PaCO₂变化率（优势比[OR] 0.994，置信区间[CI] 0.985 - 1.004，p = 0.230）与功能预后无关。然而，PaCO₂变化率（OR 1.010，CI 1.001 - 1.019，p = 0.029）与医院死亡率独立相关。
对于入院时存在高碳酸血症的院外心脏骤停（OHCA）患者，PaCO₂变化率与功能预后无独立相关性；然而，有一个显著趋势是，下降率越高，医院死亡率越高。
