Kitano Shinnosuke, Suzuki Kensuke, Tanaka Chie, Kuno Masamune, Kitamura Nobuya, Yasunaga Hideo, Aso Shotaro, Tagami Takashi
Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan.
The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan.
Resusc Plus. 2024 May 13;18:100660. doi: 10.1016/j.resplu.2024.100660. eCollection 2024 Jun.
Agonal breathing is a relatively common symptom that follows cardiac arrest when the brainstem function is preserved. Agonal breathing is associated with favorable survival in patients experiencing out-of-hospital cardiac arrest (OHCA). While previous studies focused on agonal breathing observed in the pre-hospital setting for all study subjects, we focused on agonal breathing observed upon hospital arrival. In this multicenter prospective study, we aimed to assess the prognosis of patients exhibiting agonal breathing upon hospital arrival were compared. We hypothesized that agonal breathing at hospital arrival would be associated with favorable neurological outcomes among patients with OHCA.
The data on incidence of agonal breathing were prospectively collected for all evaluable participants in a multicenter, observational study in Japan (SOS-KANTO [Survey of Survivors after Out-of-Hospital Cardiac Arrest in Kanto Area] 2017 Study). Groups with and without agonal breathing were compared upon hospital arrival. Propensity-score with inverse probability of treatment weighting (IPTW) analysis was performed to adjust for confounding factors. The primary outcome was a favorable neurological outcome (Cerebral Performance Category 1-2) at 1 month.
A total of 6,457 participants out of the 9,909 registered in SOS-KANTO 2017 (in which 42 facilities participated) were selected for the current study. There were 128 patients (2.0%) in the with-agonal breathing group and 6,329 (98.0%) in the withoutagonal breathing group. The primary outcome was 1.1% in the with-agonal breathing group and 0.6% in the without-agonal breathing group (risk difference, 0.55; 95% confidence interval, 0.23-0.87) after IPTW analysis.
In this multicenter prospective study, agonal breathing at hospital arrival was significantly associated with better neurological outcomes and increased survival at 1 month. Thus, agonal breathing at hospital arrival may be a useful prognostic predictor for patients experiencing OHCA.
濒死呼吸是心脏骤停后较为常见的症状，此时脑干功能尚存。濒死呼吸与院外心脏骤停（OHCA）患者的良好生存状况相关。既往研究关注的是所有研究对象在院前环境中观察到的濒死呼吸，而我们关注的是患者入院时观察到的濒死呼吸。在这项多中心前瞻性研究中，我们旨在评估入院时出现濒死呼吸的患者的预后并进行比较。我们假设，入院时的濒死呼吸与OHCA患者良好的神经学转归相关。
在日本一项多中心观察性研究（SOS-KANTO[关东地区院外心脏骤停幸存者调查]2017研究）中，前瞻性收集了所有可评估参与者的濒死呼吸发生率数据。比较入院时出现和未出现濒死呼吸的组。采用倾向评分逆概率加权（IPTW）分析来调整混杂因素。主要结局是1个月时良好的神经学转归（脑功能分类1-2级）。
SOS-KANTO 2017研究（42家机构参与）登记的9909名参与者中，共有6457名被选入本研究。濒死呼吸组有128例患者（2.0%），无濒死呼吸组有6329例患者（98.0%）。IPTW分析后，濒死呼吸组的主要结局为1.1%，无濒死呼吸组为0.6%（风险差异，0.55；9５%置信区间，0.23-0.87）。
在这项多中心前瞻性研究中，入院时的濒死呼吸与更好的神经学转归及1个月时生存率增加显著相关。因此，入院时的濒死呼吸可能是OHCA患者有用的预后预测指标。
