难治性心脏骤停患者中可能存在的非闭塞性肠系膜缺血与神经学预后的关系——布拉格院外心脏骤停研究的二次分析
The significance of possible non-occlusive mesenteric ischemia in relation to neurological outcomes in patients with refractory cardiac arrest - Secondary analysis of the Prague OHCA study.
作者信息
Smalcova Jana, Suen Jacky, Huptych Michal, Franek Ondrej, Kavalkova Petra, Brodska Helena Lahoda, Balik Martin, Malik Jan, Pudil Jan, Smid Ondrej, Fajkus Martin, McInerney Molly-Rose, Belohlavek Jan
机构信息
2(nd) Department of Cardiovascular Medicine, General University Hospital in Prague, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Critical Care Research Group, Brisbane, Australia; Emergency Medical Service Prague, Prague, Czech Republic.
Critical Care Research Group, Brisbane, Australia.
出版信息
Resuscitation. 2025 Sep;214:110642. doi: 10.1016/j.resuscitation.2025.110642. Epub 2025 May 15.
BACKGROUND
Intestinal injury as a consequence of ischemia-reperfusion injury after refractory cardiac arrest is not fully understood. This study evaluates the occurrence of clinical signs reflecting possible non-occlusive mesenteric ischemia (NOMI) to outcomes in patients with refractory cardiac arrest.
METHODS
In a post-hoc analysis of a randomized, prospective Prague OHCA study comparing ECPR vs. CPR approaches in refractory out-of-hospital CA, all patients who survived longer than one hour after hospital admission were analyzed. We assessed possible NOMI based on clinical signs (mainly profuse diarrhea and abdominal distension) and their onset within 12 h of admission. Its occurrence was correlated with neurologically unfavorable outcome (Cerebral Performance Category (CPC) Scale 3-5) at 180 days. Cox regression was used to evaluate the relationship of particular variables to adverse neurological outcomes.
RESULTS
Of the 256 study participants, 61 developed possible NOMI: 46 (51.7%) in the ECPR group and 15 (16.5%) in the CPR group. Adverse neurological outcomes occurred in 41 (89%) and nine (60%) patients, respectively. The number of patients developing possible NOMI was higher in those treated with ECPR (p > 0.01). Its occurrence correlated with cardiac arrest length, elevated levels of neuron-specific enolase and procalcitonin at 48 and 72 h. It was independently associated with adverse outcomes. In Cox regression, possible NOMI was associated with poor neurological outcomes in ECPR patients.
CONCLUSION
The development of profuse diarrhea, abdominal distension and other signs suggesting non-occlusive mesenteric ischemia in patients with refractory out-of-hospital cardiac arrest are observed more frequently in patients with poor neurological outcome at day 180, especially in patients treated with ECPR.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01511666.
背景
难治性心脏骤停后缺血再灌注损伤导致的肠道损伤尚未完全明确。本研究评估反映可能的非闭塞性肠系膜缺血（NOMI）的临床体征对难治性心脏骤停患者预后的影响。
方法
在一项比较体外心肺复苏（ECPR）与心肺复苏（CPR）治疗难治性院外心脏骤停的随机、前瞻性布拉格院外心脏骤停研究的事后分析中，对入院后存活超过1小时的所有患者进行分析。我们根据临床体征（主要是大量腹泻和腹胀）及其在入院12小时内的出现情况评估可能的NOMI。其发生与180天时神经功能不良结局（脑功能分类（CPC）量表3 - 5级）相关。采用Cox回归评估特定变量与不良神经结局的关系。
结果
256名研究参与者中，61人出现可能的NOMI：ECPR组46人（51.7%），CPR组15人（16.5%）。分别有41名（89%）和9名（60%）患者出现不良神经结局。接受ECPR治疗的患者中出现可能NOMI的人数更多（p>0.01）。其发生与心脏骤停持续时间、48小时和72小时时神经元特异性烯醇化酶和降钙素原水平升高相关。它与不良结局独立相关。在Cox回归中，可能的NOMI与ECPR患者的不良神经结局相关。
结论
在难治性院外心脏骤停患者中，大量腹泻、腹胀和其他提示非闭塞性肠系膜缺血的体征在180天时神经功能不良结局的患者中更常见，尤其是接受ECPR治疗的患者。
试验注册
ClinicalTrials.gov：NCT01511666。
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