接受目标温度管理的体外心肺复苏患者长期高氧血症、生存率和神经学转归的相关性：SAVE-J Ⅱ研究的回顾性观察分析
Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study.
作者信息
Takeda Tomoaki, Taniguchi Hayato, Honzawa Hiroshi, Abe Takeru, Takeuchi Ichiro, Inoue Akihiko, Hifumi Toru, Sakamoto Tetsuya, Kuroda Yasuhiro
机构信息
Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
Emergency Care Department, Yokohama City University Hospital, Yokohama, Japan.
出版信息
Resusc Plus. 2024 Nov 20;20:100831. doi: 10.1016/j.resplu.2024.100831. eCollection 2024 Dec.
BACKGROUND
Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival rates and neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA). High levels of partial pressure of arterial oxygen (PaO) negatively affect survival and neurological outcomes in patients with OHCA. However, research on associations of hyperoxemia with survival and neurological outcomes after ECPR remains limited, especially considering targeted temperature management (TTM) administration to patients. Additionally, few reports have examined the impact of hyperoxemia beyond 24 h. In this study, we aimed to examine the effect of prolonged hyperoxemia on survival and neurological outcomes after ECPR for OHCA in patients undergoing TTM.
METHODS
We performed a secondary observational analysis of data from the SAVE-J Ⅱ study, a retrospective, multicenter registry study of ECPR of patients with OHCA. Data on arterial PaO after ECPR for intensive care unit days 2-4 were collected and averaged. Patients were divided into two groups: hyperoxic (PaO ≥ 300 mmHg) and non-hyperoxic (PaO < 300 mmHg). Each variable was compared between the groups. Additionally, survival and mortality rates at discharge were compared, and factors associated with survival (primary outcome) and neurological outcomes (secondary outcome) at discharge were examined.
RESULTS
The multivariate analysis for survival at discharge showed that age, initial ventricular fibrillation/ventricular tachycardia (VF/VT) waveform, = 0.0004), and hyperoxemia were significant factors. For neurological outcomes at discharge, significant factors included age, initial VF/VT waveform, hemoglobin level at presentation, and hyperoxemia.
CONCLUSIONS
Prolonged hyperoxemia was significantly associated with worse survival and neurological outcomes after ECPR for OHCA in patients who underwent TTM.
背景
体外心肺复苏（ECPR）可提高院外心脏骤停（OHCA）患者的生存率和神经功能预后。动脉血氧分压（PaO）过高对OHCA患者的生存和神经功能预后产生负面影响。然而，关于高氧血症与ECPR后生存及神经功能预后之间关联的研究仍然有限，尤其是考虑到对患者实施目标温度管理（TTM）的情况。此外，很少有报告探讨超过24小时的高氧血症的影响。在本研究中，我们旨在探讨长时间高氧血症对接受TTM的OHCA患者ECPR后生存及神经功能预后的影响。
方法
我们对SAVE-JⅡ研究的数据进行了二次观察性分析，该研究是一项关于OHCA患者ECPR的回顾性多中心注册研究。收集并计算重症监护病房第2至4天ECPR后动脉PaO的数据。患者分为两组：高氧组（PaO≥300 mmHg）和非高氧组（PaO<300 mmHg）。对两组之间的每个变量进行比较。此外，比较出院时的生存率和死亡率，并检查与出院时生存（主要结局）和神经功能预后（次要结局）相关的因素。
结果
出院时生存的多因素分析显示，年龄、初始室颤/室性心动过速（VF/VT）波形、……（此处原文缺失部分内容）=0.0004）和高氧血症是显著因素。对于出院时的神经功能预后，显著因素包括年龄、初始VF/VT波形、入院时血红蛋白水平和高氧血症。
结论
对于接受TTM的OHCA患者，长时间高氧血症与ECPR后较差的生存和神经功能预后显著相关。
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