Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway.
Resuscitation. 2024 Aug;201:110295. doi: 10.1016/j.resuscitation.2024.110295. Epub 2024 Jun 25.
Mild hypercapnia did not improve neurological outcomes for resuscitated out-of-hospital cardiac arrest (OHCA) patients in the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. However, the effects of hypercapnic acidosis on myocardial injury in patients with cardiac arrest is unexplored. We investigated whether mild hypercapnia compared to normocapnia, following emergency coronary intervention, increased myocardial injury in comatose OHCA-patients with AMI.
Single-centre, prospective, pre-planned sub-study of the TAME trial. Patients were randomised to targeted mild hypercapnia (PaCO = 6.7-7.3 kPa) or normocapnia (PaCO = 4.7-6.0 kPa) for 24 h. Myocardial injury was assessed with high-sensitive cardiac troponin T (hs-cTnT) measured at baseline, 24, 48 and 72 h. Haemodynamics were assessed with right heart catheterisation and blood-gas analyses every 4th hour for 48 h.
We included 125 OHCA-patients. 57 (46%) had an AMI, with 31 and 26 patients randomised to hypercapnia and normocapnia, respectively. Median peak hs-cTnT in AMI-patients was 58% lower in the hypercapnia-group: 2136 (IQR: 861-4462) versus 5165 ng/L (IQR: 2773-7519), p = 0.007. Lower average area under the hs-cTnT curve was observed in the hypercapnia-group: 2353 (95% CI 1388-3319) versus 4953 ng/L (95% CI 3566-6341), P-group = 0.002. Hypercapnia was associated with increased cardiac power output (CPO) and lower lactate levels in patients with AMI (P-group < 0.05). hs-cTnT, lactate and CPO were not significantly different between intervention groups in OHCA-patients without AMI (p > 0.05).
Mild hypercapnia was not associated with increased myocardial injury in resuscitated OHCA-patients. In AMI-patients, mild hypercapnia was associated with lower hs-cTnT and lactate, and improved cardiac performance.
NCT03114033.
靶向治疗性轻度高碳酸血症后复苏心脏骤停（TAME）试验表明，轻度高碳酸血症并未改善复苏后院外心脏骤停（OHCA）患者的神经结局。然而，高碳酸酸中毒对心脏骤停患者心肌损伤的影响尚不清楚。我们研究了与正常碳酸血症相比，在紧急冠状动脉介入治疗后，昏迷的伴有急性心肌梗死（AMI）的 OHCA 患者的轻度高碳酸血症是否会增加心肌损伤。
TAME 试验的单中心、前瞻性、预先计划的子研究。患者被随机分配至目标性轻度高碳酸血症（PaCO2=6.7-7.3kPa）或正常碳酸血症（PaCO2=4.7-6.0kPa）组，持续 24 小时。基线、24、48 和 72 小时检测高敏心肌肌钙蛋白 T（hs-cTnT）评估心肌损伤。每 4 小时进行一次右心导管检查和血气分析，持续 48 小时。
我们纳入了 125 例 OHCA 患者。其中 57 例（46%）发生了 AMI，31 例和 26 例患者分别随机分配至高碳酸血症组和正常碳酸血症组。高碳酸血症组 AMI 患者的 hs-cTnT 峰值中位数降低了 58%：2136（IQR：861-4462）ng/L 与 5165ng/L（IQR：2773-7519），p=0.007。高碳酸血症组的 hs-cTnT 曲线下平均面积也较低：2353（95%CI 1388-3319）ng/L 与 4953ng/L（95%CI 3566-6341），P 组=0.002。在伴有 AMI 的患者中，高碳酸血症与心输出量（CPO）增加和乳酸水平降低相关（P 组<0.05）。在没有 AMI 的 OHCA 患者中，干预组之间的 hs-cTnT、乳酸和 CPO 无显著差异（p>0.05）。
轻度高碳酸血症与复苏后 OHCA 患者的心肌损伤增加无关。在 AMI 患者中，轻度高碳酸血症与 hs-cTnT 和乳酸降低以及心功能改善相关。
NCT03114033。
