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Association of white blood cell count with one-year mortality after cardiac arrest 白细胞计数与心脏骤停后一年死亡率的关系

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-02 DOI: 10.1016/j.resplu.2024.100816

Asser M.J. Seppä , Markus B. Skrifvars , Heidi Vuopio , Rahul Raj , Matti Reinikainen , Pirkka T. Pekkarinen

Introduction

Post-resuscitation care of cardiac arrest patients may be complicated by systemic inflammation elicited in response to whole-body ischaemia–reperfusion injury. We assessed the association between early WBC with one-year mortality in a large, unselected population of cardiac arrest patients.

Methods

We collected a retrospective multicentre cohort of ICU-treated CA patients from the Finnish national ICU registry. We used locally estimated scatterplot smoothing (LOESS) curve to assess the association between the most abnormal WBC of the first 24 h in the ICU with the likelihood of death within a year. Multivariable logistic regression analyses were performed to assess the independent association between WBC and one-year mortality. In nested cohort analysis, we tested the association of delay from collapse to return of spontaneous circulation (ROSC) with WBC in linear regression models.

Results

The LOESS curve was U-shaped, with the lowest predicted mortality at 7.5 10⁹/L WBC. Based on this cut-off value, patients were divided into high (≥ 7.5 10⁹/L) and low (< 7.5 10⁹/L) WBC groups. In 4229 patients with high WBC, higher WBC was independently associated with increased one-year mortality (adjusted odds ratio (OR) 1.03 per 10⁹/L, 95 % confidence interval (CI) 1.02–1.04, p < 0.001). In 776 patients with low WBC, lower WBC was independently associated with increased one-year mortality (adjusted OR 0.88 per 10⁹/L, 95 % CI 0.80–0.96, p < 0.001). In a nested cohort analysis, longer ROSC-delay was associated with higher WBC in patients with a shockable rhythm (β = 0.10, R² = 0.04, p < 0.001).

Conclusions

In this large retrospective cohort, WBC was independently associated with one-year mortality after CA. Mortality was lowest in patients with WBC close to the upper limit of the normal reference range. Although WBC is not useful for outcome prognostication in individual patients, our results support the concept of excess inflammation being a harmful component of the post-cardiac arrest syndrome.

导言心脏骤停患者复苏后的护理可能会因全身缺血再灌注损伤引起的全身炎症而变得复杂。我们评估了大量未经筛选的心脏骤停患者中早期白细胞与一年死亡率之间的关系。我们使用局部估计散点图平滑（LOESS）曲线来评估重症监护室头 24 小时白细胞最异常与一年内死亡可能性之间的关联。为评估白细胞与一年内死亡率之间的独立关联，进行了多变量逻辑回归分析。在嵌套队列分析中，我们在线性回归模型中检验了从昏迷到恢复自主循环（ROSC）的延迟与白细胞的关系。结果LOESS曲线呈U形，白细胞为7.5 109/L 时预测死亡率最低。根据这一临界值，患者被分为高白细胞组（≥ 7.5 109/L）和低白细胞组（< 7.5 109/L）。在 4229 例高白细胞患者中，白细胞越高，一年死亡率越高（调整后的几率比（OR）为 1.03 per 109/L，95 % 置信区间（CI）为 1.02-1.04，p < 0.001）。在 776 例白细胞较低的患者中，白细胞较低与一年期死亡率的增加独立相关（调整后 OR 为 0.88 per 109/L，95 % 置信区间 (CI) 为 0.80-0.96，p <0.001）。结论在这一大型回顾性队列中，WBC 与 CA 后的一年死亡率密切相关。白细胞接近正常参考范围上限的患者死亡率最低。虽然白细胞对个别患者的预后没有帮助，但我们的结果支持了炎症过多是心脏骤停后综合征的有害因素这一概念。

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引用次数: 0

Spatio-temporal distribution, prediction and relationship of three major acute cardiovascular events: Out-of-hospital cardiac arrest, ST-elevation myocardial infarction and stroke 三种主要急性心血管事件的时空分布、预测和关系：院外心脏骤停、ST 段抬高心肌梗死和中风

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-30 DOI: 10.1016/j.resplu.2024.100810

Angelo Auricchio , Tommaso Scquizzato , Federico Ravenda , Ruggero Cresta , Stefano Peluso , Maria Luce Caputo , Stefano Tonazzi , Claudio Benvenuti , Antonietta Mira

Background

Predicting the incidence of time-sensitive cardiovascular diseases like out-of-hospital cardiac arrest (OHCA), ST-elevation myocardial infarction (STEMI), and stroke can reduce time to treatment and improve outcomes. This study analysed the spatio-temporal distribution of OHCAs, STEMIs, and strokes, their spatio-temporal correlation, and the performance of different prediction algorithms.

Methods

Adults who experienced an OHCA, STEMI, or stroke in Canton Ticino, Switzerland from 2005 to 2022 were included. Datasets were divided into training and validation samples. To estimate and predict the yearly per-capita population incidences of OHCA, STEMI, and stroke, the integrated nested Laplace approximation (INLA), machine learning meta model (MLMM), the Naïve prediction method, and the exponential moving average were employed and compared. The relationship between OHCA, STEMI, and stroke was assessed by predicting the incidence of one condition, considering the lagged incidence of the other two as explanatory variables.

Results

We included 3,906 OHCAs, 2,162 STEMIs, and 2,536 stroke patients. INLA and MLMM yearly predicted incidence OHCA, STEMI, and stroke at municipality level with very high accuracy, outperforming the Naïve forecasting and the exponential moving average. INLA exhibited errors of zero or one event in 82%, 87%, and 72% of municipalities for OHCA, STEMI, and stroke, respectively, whereas ML had errors in 81%, 89%, and 71% of municipalities for the same conditions. INLA had a prediction error of 0.87, 0.77, and 1.50 events per year per municipality for OHCA, STEMI and stroke, whereas MLMM of 0.70, 0.74, and 1.09 events, respectively. Including in the INLA model the lagged absolute values of the other conditions as covariates improved the prediction of OHCA and stroke but not STEMI. MLMM predictions were consistently the most accurate and did not benefit from the inclusion of the other conditions as covariates. All the three diseases showed a similar spatial pattern.

Conclusions

Prediction of incidence of OHCA, STEMI, and stroke is possible with very high accuracy using INLA and MLMM models. A robust spatio-temporal correlation between the 3 pathologies exists. Widespread implementation in clinical practice of prediction algorithms may allow to improve resource allocation, reduce treatment delays, and improve outcomes.

背景预测院外心脏骤停（OHCA）、ST段抬高型心肌梗死（STEMI）和脑卒中等时间敏感性心血管疾病的发病率可缩短治疗时间并改善预后。本研究分析了院外心脏骤停、STEMI 和中风的时空分布、它们的时空相关性以及不同预测算法的性能。数据集分为训练样本和验证样本。为了估算和预测每年OHCA、STEMI和中风的人均发病率，我们采用了集成嵌套拉普拉斯近似法（INLA）、机器学习元模型（MLMM）、奈夫预测法和指数移动平均法，并进行了比较。结果我们纳入了 3906 例 OHCA、2162 例 STEMI 和 2536 例中风患者。INLA 和 MLMM 以极高的准确率预测了市级的 OHCA、STEMI 和中风发病率，优于 Naïve 预测和指数移动平均法。在 OHCA、STEMI 和中风方面，INLA 分别在 82%、87% 和 72% 的城市中显示出误差为零或一个事件，而 ML 在相同情况下分别在 81%、89% 和 71% 的城市中显示出误差。INLA 对 OHCA、STEMI 和中风的预测误差分别为每个城市每年 0.87、0.77 和 1.50 例，而 MLMM 分别为 0.70、0.74 和 1.09 例。在 INLA 模型中加入其他病症的滞后绝对值作为协变量，可以改善对 OHCA 和中风的预测，但不能改善对 STEMI 的预测。MLMM 预测一直是最准确的，并没有从将其他病症作为协变量中获益。结论使用 INLA 和 MLMM 模型可以非常准确地预测 OHCA、STEMI 和中风的发病率。这三种病症之间存在着稳健的时空相关性。在临床实践中广泛应用预测算法可以改善资源分配、减少治疗延迟并改善预后。

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引用次数: 0

Evaluation of fatigue, load and the quality of chest compressions by bystanders in hot and humid environments 对湿热环境中旁观者胸外按压的疲劳、负荷和质量进行评估

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-30 DOI: 10.1016/j.resplu.2024.100818

Haruka Takahashi , Kensuke Suzuki , Yohei Okada , Satoshi Harada , Hiroyuki Yokota , Marcus Eng Hock Ong , Satoo Ogawa

Background

This study aimed to investigate the physiological load on bystanders during cardiopulmonary resuscitation (CPR) and the quality of chest compressions in hot and humid environments.

Methods

This prospective experimental study compared the physical load and quality of chest compressions among healthy volunteers who performed 10 min chest compression in a climate chamber under normal conditions (for Tokyo) (Wet Bulb Globe Temperature [WBGT] 21 °C) and hot and humid conditions (WBGT 31 °C). The primary outcome was the depth of chest compressions over a 10-minute period. Secondary outcomes included the volunteer’s heart rate (HR), core body temperature (BT), Borg scale for assessing fatigue, and blood lactate levels. Data were analyzed using two-way repeated measures analysis of variance (ANOVA) and paired t-tests.

Results

Out of 31 participants, 29 participants (mean [SD] age: 21[0.7], male: 21 [70.5 %]) were included in the analysis. For WBGT 21 °C and 31 °C, the mean chest compression depth at 10 min was not statistically difference (the depth of chest compression: 52.2 mm and 51.5 mm (p = 0.52)). At 10 min, heart rate and core temperature were 126 vs. 143 bpm, and 37.4℃ vs. 37.5℃ for WBGT 21℃ vs. WBGT 31℃ (mean differences: 17 bpm [95 % CI: 7.7–26.3], 0.1℃ [95 % CI: −0.1–0.3]). At the end, Borg scale was 16 vs. 18 and lactate levels were 3.9 vs. 5.1 mmol/L (mean differences: 2 [95 % CI: 1–3], 1.2 mmol/L [95 % CI: 0.1–2.3]).

Conclusion

there was no significant difference in the depth of chest compression of paramedic students under the conditions between WBGT 31℃ and WBGT 21℃. For secondary outcomes, the lactate and fatigue of bystanders increased under WBGT 31℃ compared to WBGT 21℃. Further research is needed on CPR in hot and humid environments.

这项前瞻性实验研究比较了在正常条件（东京）（湿球温度 [WBGT] 21 °C）和湿热条件（WBGT 31 °C）下，健康志愿者在气候箱中进行 10 分钟胸外按压时的生理负荷和胸外按压的质量。主要结果是 10 分钟内胸外按压的深度。次要结果包括志愿者的心率（HR）、核心体温（BT）、用于评估疲劳的博格量表以及血液乳酸水平。采用双向重复测量方差分析（ANOVA）和配对 t 检验对数据进行了分析。WBGT 21 °C 和 31 °C 时，10 分钟的平均胸外按压深度没有统计学差异（胸外按压深度：52.2 mm 和 51.5 mm (p = 0.52)）。10 分钟时，WBGT 21℃ 与 WBGT 31℃ 的心率和核心温度分别为 126 bpm 与 143 bpm，37.4℃ 与 37.5℃（平均差异：17 bpm [95 % CI：7.7-26.3]，0.1℃ [95 % CI：-0.1-0.3]）。结论：在 WBGT 31℃和 WBGT 21℃条件下，护理专业学生的胸外按压深度没有显著差异。在次要结果方面，与 WBGT 21℃相比，WBGT 31℃条件下旁观者的乳酸和疲劳程度有所增加。在湿热环境中进行心肺复苏还需要进一步研究。

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引用次数: 0

Mirror, mirror, on the wall, who’s the fairest of them all? 墙上的镜子，镜子，谁最美？

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-29 DOI: 10.1016/j.resplu.2024.100812

Uri Adrian Prync Flato , Ricardo Ferreira Mendes de Oliveira , Lucas Kallas-Silva , Maria Fernanda Dias Azevedo

引用次数: 0

Influence of rescuer position and arm angle on chest compression quality: An international multicentric randomized crossover simulation trial 施救者位置和手臂角度对胸外按压质量的影响：国际多中心随机交叉模拟试验

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-29 DOI: 10.1016/j.resplu.2024.100815

Abel Nicolau , Ingrid Bispo , Marc Lazarovici , Christoffer Ericsson , Pedro Sa-Couto , Inês Jorge , Pedro Vieira-Marques , Carla Sa-Couto

Background

Success in resuscitation depends not only on the timeliness of the maneuvers but also on the quality of chest compressions. Factors such as the rescuer position and arm angle can significantly impact compression quality.

Aim

This study explores the influence of rescuer positioning and arm angle on the quality of chest compressions among healthcare professionals experienced in cardiopulmonary resuscitation.

Methods

In this international, multicentric, randomized crossover simulation trial with independent groups, healthcare professionals were assigned to one of four positions: kneeling on the floor, standing, standing on a step stool, and kneeling on the bed. Participants performed two 3-minute trials of uninterrupted chest compressions at arm angles of 90° and 105°. Compression quality was assessed, using manikin derived data.

Results

A total of 76 participants entered the study. Those using a 90° arm angle exhibited higher compression scores than those at a 105° angle. Rescuers standing on a step stool maintained higher scores over time when compared to other groups. In contrast, rescuers kneeling on the bed consistently scored below 75% throughout the trial, with particularly low scores at the 105° angle.

Conclusion

Rescuer position and arm angle significantly influence CPR quality, with a 90° arm angle and elevated positioning optimizing compression depth and effectiveness. The results recommend against kneeling on the bed due to its negative impact on chest compression quality.

背景复苏的成功不仅取决于操作的及时性，还取决于胸外按压的质量。方法在这项国际性、多中心、随机交叉模拟试验中，医护人员被分配到四种姿势之一：跪在地上、站立、站在阶梯凳上和跪在床上。参与者以 90° 和 105° 的手臂角度进行了两次 3 分钟的不间断胸外按压试验。使用人体模型得出的数据对按压质量进行了评估。与 105° 角度的参与者相比，90° 角度的参与者的按压得分更高。与其他组别相比，站在阶梯凳上的救援人员随着时间的推移得分更高。相比之下，跪在床上的施救者在整个试验过程中的得分始终低于 75%，尤其是 105° 角的施救者得分更低。结果建议不要跪在床上，因为这会对胸外按压质量产生负面影响。

{"title":"Influence of rescuer position and arm angle on chest compression quality: An international multicentric randomized crossover simulation trial","authors":"Abel Nicolau , Ingrid Bispo , Marc Lazarovici , Christoffer Ericsson , Pedro Sa-Couto , Inês Jorge , Pedro Vieira-Marques , Carla Sa-Couto","doi":"10.1016/j.resplu.2024.100815","DOIUrl":"10.1016/j.resplu.2024.100815","url":null,"abstract":"<div><h3>Background</h3><div>Success in resuscitation depends not only on the timeliness of the maneuvers but also on the quality of chest compressions. Factors such as the rescuer position and arm angle can significantly impact compression quality.</div></div><div><h3>Aim</h3><div>This study explores the influence of rescuer positioning and arm angle on the quality of chest compressions among healthcare professionals experienced in cardiopulmonary resuscitation.</div></div><div><h3>Methods</h3><div>In this international, multicentric, randomized crossover simulation trial with independent groups, healthcare professionals were assigned to one of four positions: kneeling on the floor, standing, standing on a step stool, and kneeling on the bed. Participants performed two 3-minute trials of uninterrupted chest compressions at arm angles of 90° and 105°. Compression quality was assessed, using manikin derived data.</div></div><div><h3>Results</h3><div>A total of 76 participants entered the study. Those using a 90° arm angle exhibited higher compression scores than those at a 105° angle. Rescuers standing on a step stool maintained higher scores over time when compared to other groups. In contrast, rescuers kneeling on the bed consistently scored below 75% throughout the trial, with particularly low scores at the 105° angle.</div></div><div><h3>Conclusion</h3><div>Rescuer position and arm angle significantly influence CPR quality, with a 90° arm angle and elevated positioning optimizing compression depth and effectiveness. The results recommend against kneeling on the bed due to its negative impact on chest compression quality.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100815"},"PeriodicalIF":2.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest 院外心脏骤停后急诊科入院时气管插管与喉管插管对气体测量和乳酸的影响

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-28 DOI: 10.1016/j.resplu.2024.100813

Olaf Aretz , Jana Vienna Rödler , Athina Gavriil , Marc Deussen , Emmanuel Chorianopoulos , Sebastian Bergrath

Aim

Guidelines recommend supraglottic airways (e.g. laryngeal tube, LT) for out-of-hospital cardiac arrest (OHCA) if providers are not skilled in endotracheal intubation (ETI). In prolonged cardiopulmonary resuscitation (CPR) LT led to asphyxial physiology. Therefore we evaluated the impact of LT vs. ETI on gasometry and lactate at admission.

Methods

All patients from 1 January 2020 to 30 April 2023 with return of spontaneous circulation (ROSC) or ongoing CPR (no ROSC) were included in this retrospective cohort study.

Continuous data were analysed using the Mann-Whitney-U-Test.

Results

Overall, 147 patients were included: ETI, n = 104; LT, n = 33; other airways, n = 10. ROSC, n = 86; no ROSC, n = 61. ETI vs. LT (median) for all patients showed: arterial blood gas analyses (BGA) (n = 62 vs. n = 20): pH 7.01 vs. 7.07, p = 0.83; pCO₂ 64.5 vs. 66.6 mmHg, p = 0.62; lactate 10.1 vs. 9.5 mmol/l, p = 0.68. Venous BGA (n = 37 vs. n = 11): pH 6.91 vs. 7.12, p = 0.15; pCO₂ 77.4 vs. 66.0 mmHg, p = 0.19; lactate 11.5 vs. 8.6 mmol/l, p = 0.24. ROSC, arterial BGA (n = 39 vs. n = 12): pH 7.09 vs. 7.14, p = 0.36; pCO₂ 60.3 vs. 56.4 mmHg, p = 0.84; lactate 8.95 vs. 7.0 mmol/l, p = 0.35. No ROSC, arterial BGA (n = 23 vs. n = 8): pH 6.9 vs. 6.8, p = 0.03; pCO₂ 80.7 vs. 85.6 mmHg, p = 0.64; lactate 13.0 vs. 14.6 mmol/l, p = 0.62.

Conclusion

The prehospital airway strategy had no impact on gasometry in this OHCA collective except a better pH with ETI in no ROSC. Due to small numbers and non-existent data about the exact prehospital ventilation parameters, further prospective studies are needed to evaluate this question.

如果医护人员不熟练气管插管 (ETI)，《指南》建议对院外心脏骤停 (OHCA) 采用声门上气道（如喉导管，LT）。在长时间的心肺复苏（CPR）中，喉管插管会导致窒息生理。这项回顾性队列研究纳入了 2020 年 1 月 1 日至 2023 年 4 月 30 日期间自发循环恢复（ROSC）或正在进行心肺复苏（无 ROSC）的所有患者：ETI，104 人；LT，33 人；其他气道，10 人。ROSC：86人；无ROSC：61人。所有患者的 ETI 与 LT（中位数）对比显示：动脉血气分析（BGA）（n = 62 vs. n = 20）：pH 7.01 vs. 7.07，p = 0.83；pCO2 64.5 vs. 66.6 mmHg，p = 0.62；乳酸 10.1 vs. 9.5 mmol/l，p = 0.68。静脉 BGA（n = 37 vs. n = 11）：pH 6.91 vs. 7.12，p = 0.15；pCO2 77.4 vs. 66.0 mmHg，p = 0.19；乳酸 11.5 vs. 8.6 mmol/l，p = 0.24。ROSC，动脉 BGA（n = 39 vs. n = 12）：pH 7.09 vs. 7.14，p = 0.36；pCO2 60.3 vs. 56.4 mmHg，p = 0.84；乳酸 8.95 vs. 7.0 mmol/l，p = 0.35。无 ROSC，动脉 BGA（n = 23 vs. n = 8）：pH 6.9 vs. 6.8，p = 0.03；pCO2 80.7 vs. 85.6 mmHg，p = 0.64；乳酸 13.0 vs. 14.6 mmol/l，p = 0.62。由于院前通气参数的确切数据较少且不存在，因此需要进一步的前瞻性研究来评估这一问题。

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引用次数: 0

The relationship between race and emergency medical services resuscitation intensity for those in refractory-arrest 种族与紧急医疗服务对难治性休克患者的抢救强度之间的关系

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-25 DOI: 10.1016/j.resplu.2024.100806

Justin Yap , Jacob Hutton , Marina Del Rios , Frank Scheuermeyer , Malini Nair , Laiba Khan , Emad Awad , Takahisa Kawano , Valerie Mok , Jim Christenson , Brian Grunau

Background

Previous studies have reported race-based health disparities in North America. It is unknown if emergency medical service (EMS) treatment of out-of-hospital cardiac arrest (OHCA) varies based on race. We sought to compare markers of resuscitation intensity among different racial groups.

Methods

Using data of adult EMS-treated OHCAs from the Trial of Continuous or Interrupted Chest Compressions During CPR, we analyzed data from participants for whom on-scene return of spontaneous circulation (ROSC) was not achieved. We fit multivariate regression models using a generalized estimating equation, to estimate the association between patient race (White vs. Black vs. “Other”) and the following markers for resuscitation intensity: (1) resuscitation attempt duration; (2) intra-arrest transport; (3) number of epinephrine doses; (4) EMS arrival-to-CPR interval, and (5) 9–1–1 to first shock.

Results

From our study cohort of 5370 cases, the median age was 65 years old (IQR: 53–78), 2077 (39 %) were women, 2121 (39 %) were Black, 596 (11 %) were “Other race”, 2653 (49 %) were White, and 4715 (88 %) occurred in a private location. With reference to White race, Black race was associated with a longer resuscitation attempt duration and a lower number of epinephrine doses; Black and “Other” race were both associated with a lower odds of intra-arrest transport.

Conclusion

We identified race-based differences in EMS resuscitation intensity for OHCA within a North American cohort, although 40% of race data was missing from this dataset. Future research investigating race-based differences in OHCA management may be warranted.

背景以前的研究报告了北美基于种族的健康差异。院外心脏骤停（OHCA）的急救医疗服务（EMS）治疗是否因种族而异尚属未知。我们试图比较不同种族群体的复苏强度指标。方法利用 "心肺复苏期间持续或间断胸外按压试验"（Trial of Continuous or Interrupted Chest Compressions During CPR）中的成人院外心脏骤停急救服务（EMS）治疗数据，我们分析了未实现现场自发循环（ROSC）恢复的参与者的数据。我们使用广义估计方程拟合了多变量回归模型，以估算患者种族（白人 vs. 黑人 vs. "其他"）与以下复苏强度指标之间的关系：(1) 复苏尝试持续时间；(2) 复苏过程中的转运；(3) 肾上腺素剂量；(4) 紧急医疗服务到达到心肺复苏的时间间隔；以及 (5) 9-1-1 到首次休克。结果在我们的 5370 例研究队列中，中位年龄为 65 岁（IQR：53-78），2077 例（39%）为女性，2121 例（39%）为黑人，596 例（11%）为 "其他种族"，2653 例（49%）为白人，4715 例（88%）发生在私人场所。与白人相比，黑人的复苏尝试持续时间较长，肾上腺素剂量较少；黑人和 "其他种族 "的复苏尝试持续时间较长，肾上腺素剂量较少；黑人和 "其他种族 "的复苏尝试持续时间较长，肾上腺素剂量较少；黑人和 "其他种族 "的复苏尝试持续时间较长，肾上腺素剂量较少；黑人和 "其他种族 "的复苏尝试持续时间较长，肾上腺素剂量较少；黑人和 "其他种族 "的复苏尝试持续时间较长，肾上腺素剂量较少。今后可能需要对基于种族的 OHCA 管理差异进行研究。

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引用次数: 0

Factors associated with neurological outcomes in patients experiencing out-of-hospital cardiac arrest and severe acidaemia: retrospective analysis of a nation-wide registry 院外心脏骤停和重度酸血症患者神经系统预后的相关因素：对全国登记数据的回顾性分析

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-25 DOI: 10.1016/j.resplu.2024.100809

Makoto Watanabe , Tetsuhisa Kitamura , Bon Ohta , Tasuku Matsuyama

Background and objective

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.

Methods

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.

Results

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]).

Conclusion

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.

背景和目的院外心脏骤停（OHCA）患者中常见的是酸中毒。虽然严重的酸中毒是预示不良预后的一个重要因素，但也有一部分患者表现出显著的恢复。尽管这些结果相互矛盾，但人们对发生院外心脏骤停并伴有严重酸血症的患者神经系统预后的相关因素却知之甚少。分析对象包括入院时血液 pH 值数据可用的 OHCA 成年患者。主要结果是神经功能良好的 30 天存活率，即格拉斯哥-匹兹堡脑功能分类评分为 1 分或 2 分。如果患者的血液pH值≤6.8，则将其归类为重度酸血症。结果 49,044 名患者的数据被纳入分析，其中 16,620 名患者表现为严重酸血症，pH 中位数为 6.70（四分位数间距 [IQR] 6.61-6.76），0.5%（86/16,620）患者的神经功能转归良好。在对重要的预后因素进行调整后，目击者状态与良好的神经功能预后密切相关（调整赔率比 [aOR] 6.46 [95% 置信区间 (CI)2.64-15.8]），而初始血液 pH 值与此无显著关系（每增加 0.1 个单位，赔率比为 0.90 [95% CI 0.71-1.14]）。证人身份对这些患者的预后至关重要。

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引用次数: 0

Association of cumulative oxygen and carbon dioxide levels with neurologic outcome after pediatric cardiac arrest resuscitation: A multicenter cohort study 累积氧气和二氧化碳水平与小儿心脏骤停复苏后神经系统预后的关系：多中心队列研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-24 DOI: 10.1016/j.resplu.2024.100804

Marijn Albrecht , Rogier C.J. de Jonge , Jimena Del Castillo , Andrea Christoff , Matthijs De Hoog , Sangmo Je , Vinay M. Nadkarni , Dana E. Niles , Oliver Tegg , Kari Wellnitz , Corinne M.P. Buysse , pediRES-Q Collaborative Investigators

Objective

We aimed to (1) determine the association between cumulative PaO₂ and PaCO₂ exposure 24 h post-return of circulation and survival with favorable neurologic outcome. And (2) to assess adherence to American Heart Association post-cardiac arrest care treatment goals (PaO₂ 75–100 mmHg and PaCO₂ 35–45 mmHg).

Design and setting

Prospectively collected data were analysed from five Pediatric Resuscitation Quality collaborative sites supplemented with retrospective PaO₂ and PaCO₂ data.

Patients

Children aged 1 day–17 years with return of circulation after cardiac arrest, admitted 2019–2022, with ≥ 4 arterial blood gasses spanning at least 12 h within 24 h post-return of ciculation, were eligible. Congenital cyanotic heart disease events were excluded.

Measurements

Area under the curve calculation provided hourly cumulative PaO₂ and PaCO₂ exposures per child and similarly guideline recommended cumulative ranges. The primary outcome was survival to hospital discharge with favorable neurologic outcome defined as a Pediatric Cerebral Performance Category 1–3, or no pre-arrest baseline difference.

Main results

Among 292 included children (median age 2.6 years (IQR 0.4–10.9)), 57 % survived to discharge and 48 % had favorable neurologic outcome (88 % of survivors). Cumulative PaO₂ and PaCO₂ exposure 0–24 h post-return of circulation were not significantly associated with favorable neurologic outcome in multivariable analysis (OR 1.0, 95 %CI 0.98–1.02 and OR 0.97, 95 %CI 0.87–1.09 respectively). Cumulative PaO₂ and PaCO₂ remained within guideline recommended ranges for 24 % and 58 % of children respectively with median areas under the curve over 0 – 24 h of 2664 mmHg (2151 – 3249 mmHg) for PaO₂ and 948 mmHg (853 – 1051 mmHg) for PaCO₂. AHA post-cardiac arrest care guideline recommendations for PaO₂ (1800–2400 mmHg) and PaCO₂ (840–1080 mmHg) were recalculated as area under the curve ranges. Achieving both normoxia and normocapnia was observed in 12 % of children.

Conclusions

Cumulative PaO₂ and PaCO₂ exposure in the first 24 h post-return of circulation was not associated with survival with favorable neurologic outcome. Pediatric AHA post-cardiac arrest care guideline normoxia and normocapnia goals were often not met. Larger cohort studies are necessary to improve the accuracy of cumulative exposure calculations, assess the long-term effects of PaO₂ and PaCO₂ exposure, and explore the influence of other post-cardiac arrest care therapeutic strategies.

目的我们的目的是：(1) 确定循环恢复后 24 小时内累积 PaO2 和 PaCO2 暴露与神经系统良好预后存活率之间的关系。2）评估美国心脏协会心脏骤停后护理治疗目标（PaO2 75-100 mmHg 和 PaCO2 35-45 mmHg）的遵守情况。设计和环境分析了从五个儿科复苏质量合作站点收集的前瞻性数据，并补充了回顾性 PaO2 和 PaCO2 数据。患者年龄为 1 天-17 岁的儿童，心脏骤停后循环恢复，2019 年-2022 年入院，在循环恢复后 24 小时内动脉血气≥ 4 次，时间跨度至少 12 小时。先天性紫绀型心脏病事件被排除在外。测量曲线下面积计算提供了每名儿童每小时的累积PaO2和PaCO2暴露量，以及类似指南推荐的累积范围。主要结果292 名患儿（中位年龄 2.6 岁（IQR 0.4-10.9））中，57% 的患儿存活至出院，48% 的患儿有良好的神经功能（88% 的存活者）。在多变量分析中，循环恢复后 0-24 小时的累积 PaO2 和 PaCO2 暴露与良好的神经功能预后无显著相关性（OR 1.0，95 %CI 0.98-1.02 和 OR 0.97，95 %CI 0.87-1.09）。24%和58%的儿童的累积PaO2和PaCO2分别保持在指南推荐的范围内，0-24小时的曲线下中值分别为：PaO2 2664 mmHg（2151 - 3249 mmHg），PaCO2 948 mmHg（853 - 1051 mmHg）。AHA 心脏骤停后护理指南建议的 PaO2（1800-2400 mmHg）和 PaCO2（840-1080 mmHg）被重新计算为曲线下面积范围。结论循环恢复后最初 24 小时内累积的 PaO2 和 PaCO2 暴露与存活率和良好的神经功能预后无关。儿科 AHA 心脏骤停后护理指南中的正常氧和正常碳酸血症目标通常无法达到。有必要进行更大规模的队列研究，以提高累积暴露计算的准确性，评估 PaO2 和 PaCO2 暴露的长期影响，并探讨其他心脏骤停后护理治疗策略的影响。

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引用次数: 0

The association between early hypotension and neurologic outcome after pediatric cardiac ECPR in children with cardiac disease 心脏病患儿进行小儿心脏电复律术后早期低血压与神经系统预后的关系

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-10-24 DOI: 10.1016/j.resplu.2024.100808

Priscilla Yu , Sierra Foster , Xilong Li , Priya Bhaskar , Michael Morriss , Sumit Singh , Tyler Burr , Deepa Sirsi , Lakshmi Raman , Javier J. Lasa

Objective

Explore the relationship between early hypotension after ECPR and survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in children with cardiac disease.

Methods

Retrospective cohort study of patients undergoing ECPR at a single center pediatric cardiac intensive care unit. Hypotension was defined as MAP < 5th percentile for age. Primary and secondary exposure variables were presence and burden of hypotension respectively, during the first 6 h after ECPR. Our primary outcome was SHD with FNO defined by Pediatric Cerebral Performance Category score of 1–3 or no change from baseline. Secondary outcomes included acute central nervous system (CNS) injury via neuroimaging and EEG. Univariate and multivariable logistic regression analyses were performed.

Results

We analyzed 82 index ECPR events from 2010 to 2022. Hypotension was observed for at least one MAP value in 36/82 (43.9%) of the cohort. The median [IQR] burden of hypotension was 0 [0,14.3]%. Patients with SHD with FNO had shorter CPR duration, lower number of epinephrine and calcium doses, and lower maximum lactate levels when compared to patients who died or had SHD without FNO. After controlling for potential confounders, there was no association between presence of hypotension or burden of hypotension and SHD, SHD with FNO, or acute CNS injury via neuroimaging and EEG.

Conclusion

In children with cardiac disease, there was no association between early hypotension after ECPR and SHD with FNO. Multicenter studies are needed to better understand how early hypotension after ECPR affects neurologic outcomes in children with cardiac disease.

方法对在单中心儿科心脏重症监护病房接受 ECPR 的患者进行回顾性队列研究。低血压定义为 MAP < 年龄的第 5 百分位数。主要和次要暴露变量分别为 ECPR 术后 6 小时内低血压的存在和负担。我们的主要结果是 SHD，FNO 的定义是小儿脑功能分类评分为 1-3 分或与基线相比无变化。次要结果包括神经影像学和脑电图显示的急性中枢神经系统（CNS）损伤。结果我们分析了2010年至2022年的82例ECPR事件。36/82（43.9%）的队列中至少有一个 MAP 值观察到低血压。低血压发生率的中位数[IQR]为0 [0,14.3]%。与死亡或无 FNO 的 SHD 患者相比，有 FNO 的 SHD 患者心肺复苏持续时间更短、肾上腺素和钙剂用量更少、最大乳酸水平更低。在控制了潜在的混杂因素后，低血压的存在或低血压的负担与 SHD、SHD 伴 FNO 或神经影像学和脑电图显示的急性中枢神经系统损伤之间没有关联。需要进行多中心研究，以更好地了解 ECPR 后早期低血压如何影响心脏病患儿的神经系统预后。

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引用次数: 0