Hall Nicolas, Métrailler-Mermoud Jessika, Cools Evelien, Fehlmann Christophe, Carron Pierre-Nicolas, Rousson Valentin, Grabherr Silke, Schrag Bettina, Kirsch Matthias, Frochaux Vincent, Pasquier Mathieu
Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Emergency Service, Hôpital du Valais, Sion, Switzerland.
Resusc Plus. 2023 Aug 10;15:100443. doi: 10.1016/j.resplu.2023.100443. eCollection 2023 Sep.
Our goal was to study hypothermic cardiac arrest (CA) patients who were not rewarmed by Extracorporeal Life Support (ECLS) but were admitted to a hospital equipped for it. The focus was on whether the decisions of non-rewarming, meaning termination of resuscitation, were compliant with international guidelines based on serum potassium at hospital admission.
We retrospectively included all hypothermic CA who were not rewarmed, from three Swiss centers between 1st January 2000 and 2nd May 2021. Data were extracted from medical charts and assembled into two groups for analysis according to serum potassium. We identified the criteria used to terminate resuscitation. We also retrospectively calculated the HOPE score, a multivariable tool predicting the survival probability in hypothermic CA undergoing ECLS rewarming.
Thirty-eight victims were included in the study. The decision of non-rewarming was compliant with international guidelines for 12 (33%) patients. Among the 36 patients for whom the serum potassium was measured at hospital admission, 24 (67%) had a value that - alone - would have indicated ECLS. For 13 of these 24 (54%) patients, the HOPE score was <10%, meaning that ECLS was not indicated. The HOPE estimation of the survival probabilities, when used with a 10% threshold, supported 23 (68%) of the non-rewarming decisions made by the clinicians.
This study showed a low adherence to international guidelines for hypothermic CA patients. In contrast, most of these non-rewarming decisions made by clinicians would have been compliant with current guidelines based on the HOPE score.
我们的目标是研究未通过体外生命支持（ECLS）复温但被收治于具备该设备医院的低温心脏骤停（CA）患者。重点在于不进行复温（即终止复苏）的决策是否符合基于入院时血清钾水平的国际指南。
我们回顾性纳入了2000年1月1日至2021年5月2日期间来自瑞士三个中心的所有未进行复温的低温CA患者。数据从病历中提取，并根据血清钾水平分为两组进行分析。我们确定了用于终止复苏的标准。我们还回顾性计算了HOPE评分，这是一种多变量工具，用于预测接受ECLS复温的低温CA患者的生存概率。
38名受害者被纳入研究。12名（33%）患者不进行复温的决策符合国际指南。在入院时测量血清钾水平的36名患者中，24名（67%）的血清钾水平单独来看就表明应进行ECLS。在这24名患者中的13名（54%）患者中，HOPE评分<10%，这意味着不建议进行ECLS。当以10%的阈值使用时，HOPE对生存概率的估计支持了临床医生做出的23项（68%）不进行复温的决策。
本研究表明低温CA患者对国际指南的遵循率较低。相比之下，临床医生做出的这些不进行复温的决策大多数基于HOPE评分会符合当前指南。
