Shea Meredith G, Balaji Lakshman, Grossestreuer Anne V, Issa Mahmoud S, Silverman Jeremy, Li Franklin, Donnino Michael W, Berg Katherine M
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Rosenberg 2, Boston, MA 02215, USA.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Rosenberg 2, Boston, MA 02215, USA.
Resusc Plus. 2024 May 23;19:100667. doi: 10.1016/j.resplu.2024.100667. eCollection 2024 Sep.
Whether changes in oxygen metabolism, as measured by oxygen consumption (VO), carbon dioxide production (VCO) and the respiratory exchange ratio (RER), are associated with survival after cardiac arrest is poorly understood. In this prospective observational study, we investigated the association between VO, VCO, and RER in the initial 12 and 24 h after return of spontaneous circulation (ROSC) and survival to hospital discharge.
Adults with ROSC after cardiac arrest, admitted to the intensive care unit, requiring mechanical ventilation and treated with targeted temperature management were included. VO and VCO were measured continuously for 24 h after ROSC, using a noninvasive anesthesia monitor. Area under the curve for VO, VCO & RER was calculated using all available values over 12 and 24 h after ROSC. Using logistic regression, we evaluated the relationship between these metabolic variables and survival to hospital discharge. Analyses were adjusted for temperature, vasopressors, and neuromuscular blockade.
Sixty four patients were included. Mean age was 64 ± 16 years, and 59% were women. There was no significant association between the area under the curve of VO or VCO and survival. A higher RER in the initial 12 h was associated with better survival (aOR = 3.97, 95% CI [1.01,15.6], p = 0.048). Survival was lower in those with median RER < 0.7 in the initial 12 h compared with those with a median RER ≥ 0.7 (25% vs 67%, p = 0.011).
Higher RER in the initial 12 h was associated with survival after cardiac arrest. The etiology of unusually low RERs in this patient population remains unclear.
通过耗氧量（VO）、二氧化碳产生量（VCO）和呼吸交换率（RER）来衡量的氧代谢变化与心脏骤停后的生存率之间的关系尚不清楚。在这项前瞻性观察研究中，我们调查了自主循环恢复（ROSC）后最初12小时和24小时内VO、VCO和RER与出院生存率之间的关联。
纳入心脏骤停后出现ROSC、入住重症监护病房、需要机械通气并接受目标温度管理治疗的成年人。使用无创麻醉监测仪在ROSC后连续24小时测量VO和VCO。使用ROSC后12小时和24小时内的所有可用值计算VO、VCO和RER的曲线下面积。使用逻辑回归，我们评估了这些代谢变量与出院生存率之间的关系。分析对温度、血管加压药和神经肌肉阻滞进行了校正。
纳入64例患者。平均年龄为64±16岁，59%为女性。VO或VCO曲线下面积与生存率之间无显著关联。最初12小时内较高的RER与更好的生存率相关（调整后比值比[aOR]=3.97，95%置信区间[CI][1.01,15.6]，p=0.048）。最初12小时内RER中位数<0.7的患者与RER中位数≥0.7的患者相比，生存率较低（25%对67%，p=0.011）。
最初12小时内较高的RER与心脏骤停后的生存率相关。该患者群体中RER异常低的病因仍不清楚。
