Mair P, Kornberger E, Furtwaengler W, Balogh D, Antretter H
Department of Anesthesia and Intensive Care Medicine, University of Innsbruck School of Medicine, Austria.
Resuscitation. 1994 Jan;27(1):47-54. doi: 10.1016/0300-9572(94)90021-3.
The aim of this retrospective study was to investigate whether plasma potassium, pH and activated clotting time (ACT), obtained from a central venous blood sample immediately after admission to hospital, could predict outcome in patients with severe accidental hypothermia and cardiocirculatory arrest. Twenty-two patients rewarmed with cardiopulmonary bypass were studied retrospectively (12 patients after avalanche accidents, seven patients after cold water submersion and three patients after prolonged exposure to cold). In 12 patients stable spontaneous circulation could not be restored. In 10 patients stable spontaneous circulation could be restored. Two of these 10 patients survived long-term. Plasma potassium, central venous pH and ACT were clinically useful prognostic markers in hypothermic arrest victims after avalanche accidents: a plasma potassium value exceeding 9 mmol/l, a pH equal to or less than 6.50 or an ACT exceeding 400 s was seen in patients in whom spontaneous circulation could not be restored. Plasma potassium, central venous pH and ACT were of only limited prognostic value in hypothermic arrest victims following cold water submersion or prolonged exposure to cold. In hypothermic arrest victims after cold water submersion a central venous pH as low as 6.51 on admission did not exclude long-term survival. Moderate and severe hyperkalemia in arrest victims after prolonged exposure to cold need not necessarily indicate postmortem autolysis. A decision to continue or terminate resuscitation cannot be based on laboratory parameters. Nevertheless, our data suggest that plasma potassium, central venous pH and ACT on admission can be used to identify hypothermic arrest victims in whom death preceded cooling. If several hypothermic arrest victims are admitted simultaneously after avalanche accidents, these 3 parameters can help not to waste limited cardiopulmonary bypass facilities for patients with no hope of survival.
这项回顾性研究的目的是调查入院后立即从中心静脉血样中获取的血浆钾、pH值和活化凝血时间（ACT）能否预测严重意外低温和心循环骤停患者的预后。对22例接受体外循环复温的患者进行了回顾性研究（12例雪崩事故后患者、7例冷水浸没后患者和3例长期暴露于寒冷环境后患者）。12例患者未能恢复稳定的自主循环。10例患者恢复了稳定的自主循环。这10例患者中有2例长期存活。血浆钾、中心静脉pH值和ACT是雪崩事故后低温骤停受害者临床上有用的预后标志物：在未能恢复自主循环的患者中，血浆钾值超过9 mmol/L、pH值等于或小于6.50或ACT超过400秒。血浆钾、中心静脉pH值和ACT在冷水浸没或长期暴露于寒冷后的低温骤停受害者中预后价值有限。在冷水浸没后的低温骤停受害者中，入院时中心静脉pH值低至6.51并不排除长期存活。长期暴露于寒冷后的骤停受害者中度和重度高钾血症不一定表明死后自溶。不能根据实验室参数决定继续或终止复苏。然而，我们的数据表明，入院时的血浆钾、中心静脉pH值和ACT可用于识别在降温前已死亡的低温骤停受害者。如果在雪崩事故后同时收治多名低温骤停受害者，这三个参数有助于避免将有限的体外循环设备浪费在没有存活希望的患者身上。
