Watanabe Makoto, Kitamura Tetsuhisa, Ohta Bon, Matsuyama Tasuku
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Resusc Plus. 2024 Oct 25;20:100809. doi: 10.1016/j.resplu.2024.100809. eCollection 2024 Dec.
Acidaemia is common among individuals who experience out-of-hospital cardiac arrest (OHCA). While severe acidaemia is a strong predictor of unfavourable outcomes, a subset of patients exhibits dramatic recovery. Despite these conflicting outcomes, little is known about the factors associated with neurological outcomes in those who experience OHCA with severe acidaemia.
This retrospective analysis used data from a Japanese multicentre nationwide database, the Japanese Association for Acute Medicine OHCA Registry. The analysis included data from adult patients with OHCA for whom blood pH data were available upon arrival to hospital. The primary outcome was 30-day survival with favourable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category score of 1 or 2. Patients were categorised with severe acidaemia if their blood pH was ≤ 6.8. Factors associated with favourable outcomes were investigated using multiple logistic regression analysis.
Data from 49,044 patients were included in the analysis, of whom 16,620 exhibited severe acidaemia with a median pH of 6.70 (interquartile range [IQR] 6.61-6.76], and 0.5% (86/16,620) experienced a neurologically favourable outcome. After adjustment for important prognostic factors, witnessed status exhibited a strong association with favourable neurological outcome (adjusted odds ratio [aOR] 6.46 [95% confidence interval (CI) 2.64-15.8]), while initial blood pH exhibited no significant association (aOR 0.90 with every 0.1 unit increase [95% CI 0.71-1.14]).
Although the number is small, a notable number of patients with severe acidaemia exhibited good neurological recovery. Witness status was critical for the prognosis of these patients.
酸血症在院外心脏骤停（OHCA）患者中很常见。虽然严重酸血症是不良预后的有力预测指标，但有一部分患者会出现显著恢复。尽管存在这些相互矛盾的结果，但对于发生严重酸血症的OHCA患者，与神经学预后相关的因素却知之甚少。
这项回顾性分析使用了来自日本多中心全国性数据库——日本急性医学协会OHCA登记处的数据。分析纳入了到达医院时可获得血pH数据的成年OHCA患者的数据。主要结局是30天存活且神经学预后良好，定义为格拉斯哥 - 匹兹堡脑功能分类评分为1或2。如果患者的血pH≤6.8，则被归类为严重酸血症。使用多因素逻辑回归分析研究与良好预后相关的因素。
49044例患者的数据纳入了分析，其中16620例表现为严重酸血症，中位pH为6.70（四分位间距[IQR]6.61 - 6.76），0.5%（86/16620）的患者神经学预后良好。在对重要的预后因素进行调整后，目击状态与良好的神经学预后密切相关（调整后的优势比[aOR]6.46[95%置信区间（CI）2.64 - 15.8]），而初始血pH无显著关联（每增加0.1个单位，aOR为0.90[95%CI 0.71 - 1.14]）。
尽管数量较少，但相当数量的严重酸血症患者表现出良好的神经学恢复。目击状态对这些患者的预后至关重要。
