Woo Jae-Hyug, Lim Yong Su, Cho Jin Seong, Yang Hyuk Jun, Jang Jae Ho, Choi Jea Yeon, Choi Woo Sung
Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea.
J Clin Med. 2023 Jul 31;12(15):5040. doi: 10.3390/jcm12155040.
Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline.
A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality.
Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater ( = 0.044 and = 0.024, respectively) and the incidence of hyperchloremia was lower ( < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes.
Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients.
尽管生理盐水常用于心肺复苏（CPR）或心脏骤停后护理，但它有不利影响。本试验旨在评估平衡晶体溶液（血浆溶液-A [PS]）对院外心脏骤停（OHCA）患者的疗效，并将其与生理盐水的疗效进行比较。
在一所三级大学医院急诊科收治的非创伤性OHCA患者的心肺复苏及心脏骤停后护理期间，进行了一项使用PS和生理盐水进行静脉输液的随机、非盲临床试验。患者在入院后24小时内接受生理盐水（生理盐水组）或PS（PS组）。主要结局是24小时内动脉pH值、碳酸氢盐、碱剩余（BE）和氯离子水平的变化。次要结局是包括死亡率在内的临床结局。
在364例患者中，分别分析了生理盐水组和PS组27例和26例患者的数据。使用线性混合模型分析显示，两组间BE随时间的变化存在显著差异（治疗×时间 = 0.044）。PS组从30分钟到2小时BE和碳酸氢盐水平的升高显著更大（分别为 = 0.044和 = 0.024），且高氯血症的发生率低于生理盐水组（ < 0.001）。然而，临床结局并无差异。
在OHCA患者中，与使用生理盐水相比，使用PS进行复苏可使BE和碳酸氢盐更快改善，尤其是在心脏骤停后护理的早期阶段，且高氯血症发生率更低，而临床结局无差异。
