Department of Internal Medicine A, Hadassah Hebrew University Medical Center, Kalman Yaakov Man St, Ein Kerem, 91120, Jerusalem, Israel.
Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Intern Emerg Med. 2024 Jan;19(1):159-173. doi: 10.1007/s11739-023-03389-3. Epub 2023 Aug 17.
Information on extracerebral system dysfunction is important for assessing the needs of critically ill patients after cardiac arrest.
To describe the prevalence of organ dysfunction and patient severity after out of hospital cardiac arrest (OHCA) using scores commonly used in intensive care and the association between these and mortality.
Retrospective analysis of observational data collected in real time in a tertiary medical center where care withdrawal is mostly illegal. Adult patients after nontraumatic OHCA with ROSC who survived for more than two hours were included. Primary outcome-prevalence of organ failure, based on common definitions for organ dysfunction, in the 1 days of hospitalization. Secondary outcomes-rates of survival to hospital discharge and survival with a good neurological outcome (CPC 1 or 2), and associations between organ dysfunction SOFA and APACHE-II scores and outcomes. Associations were assessed using fisher's exact test for categorical variables and Mann-Whitney and T test for continuous variables. Multivariable models were also constructed for all measurements showing associations in previous tests. For severity scores compatibility, we used receiver-operating curve (ROC).
Overall 369 patients (median age 75 years, 65% male) were included. Most arrests (64%) were witnessed, bystander CPR was provided in 15%. Median call to arrival time was 4 min. The presenting rhythm was asystole in 48% and VT/VF in 22%. Cardiovascular causes of arrest predominated (48%, n = 178). The median length of hospitalization was 5 days. Overall 28% of the patients (n = 98) survived to hospital discharge, mostly with a good neurological status (18.7%, n = 57). The rates of organ dysfunction were: hemodynamic instability 65% (n = 247), respiratory dysfunction 94% (n = 296), kidney dysfunction 70% (n = 259), hepatic dysfunction 14% (n = 50). The median SOFA score on day 1 was 9 and the median APACHE II score was 34. Modeling was limited by missing data. Neurological dysfunction (i.e. GCS and seizures) and kidney injury were consistently correlated with the outcomes in the multivariable models. Severity of critical illness assessed by above scoring systems correlated with mortality (all ROC curves had an AUC ranging between 0.728 and 0.849).
Multiorgan failure is common after ROSC (1-4). Therefore, the management of patients after ROSC may require advanced multidisciplinary care. Scores describing the severity of critical illness should be routinely reported in resuscitation research. Our unique setting where withdrawal of care is illegal, allows assessment of extremely ill patients and may assist in defining margins for futility.
了解心搏骤停后患者的脑外系统功能障碍信息对于评估危重症患者的需求非常重要。
使用重症监护中常用的评分方法描述院外心搏骤停（OHCA）后器官功能障碍和患者严重程度，并探讨这些评分与死亡率之间的关系。
对在一家三级医疗中心实时收集的观察性数据进行回顾性分析，该中心的撤机治疗大多是违法的。纳入存活超过 2 小时且无创伤性 OHCA 后接受 ROSC 的成年患者。主要结局-住院第 1 天常见器官功能障碍定义的器官衰竭发生率。次要结局-出院时的生存率和良好神经结局（CPC 1 或 2）的生存率，以及器官功能障碍 SOFA 和 APACHE-II 评分与结局之间的相关性。使用 Fisher 精确检验评估分类变量的相关性，使用 Mann-Whitney 和 T 检验评估连续变量的相关性。对于在之前的测试中显示相关性的所有测量值，还构建了多变量模型。为了评估严重程度评分的兼容性，我们使用了接收器工作特征曲线（ROC）。
共有 369 例患者（中位年龄 75 岁，65%为男性）入选。64%的患者为目击心搏骤停，15%的患者接受了旁观者心肺复苏。中位从呼叫到到达时间为 4 分钟。出现的节律为 48%的停搏和 22%的室性心动过速/心室颤动。心搏骤停的心血管原因占主导地位（48%，n=178）。中位住院时间为 5 天。28%的患者（n=98）存活至出院，大多数患者的神经状态良好（18.7%，n=57）。器官功能障碍的发生率为：血流动力学不稳定 65%（n=247），呼吸功能障碍 94%（n=296），肾功能障碍 70%（n=259），肝功能障碍 14%（n=50）。第 1 天的中位 SOFA 评分为 9 分，中位 APACHE II 评分为 34 分。由于数据缺失，建模受到限制。多变量模型中，神经功能障碍（即 GCS 和癫痫发作）和肾脏损伤与结局始终相关。上述评分系统评估的危重病严重程度与死亡率相关（所有 ROC 曲线的 AUC 范围为 0.728 至 0.849）。
ROS 后多器官衰竭很常见（1-4）。因此，ROS 后患者的管理可能需要先进的多学科护理。应常规报告描述危重病严重程度的评分，以用于复苏研究。我们的研究环境独特，撤机治疗违法，允许评估极度危重病患者，并可能有助于确定无效治疗的界限。
