Abstract：
BACKGROUND: In-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. The objective of this study was to study the association of arterial carbon dioxide tension (PaCO2) on survival to discharge and favorable neurologic outcomes in adults with IHCA.
METHODS: The study population included 353 adults who underwent resuscitation from 2011 to 2019 for IHCA at an academic tertiary care medical center with arterial blood gas testing done within 24 hours of arrest. Outcomes of interest included survival to discharge and favorable neurologic outcome, defined as Glasgow outcome score of 4-5.
RESULTS: Of the 353 patients studied, PaCO2 classification included: hypocapnia (PaCO2 <35 mm Hg, n = 89), normocapnia (PaCO2 35-45 mm Hg, n = 151), and hypercapnia (PaCO2 >45 mm Hg, n = 113). Hypercapnic patients were further divided into mild (45 mm Hg < PaCO2 ≤55 mm Hg, n = 62) and moderate/severe hypercapnia (PaCO2 > 55 mm Hg, n = 51). Patients with normocapnia had the highest rates of survival to hospital discharge (52.3% vs. 32.6% vs. 30.1%, P < 0.001) and favorable neurologic outcome (35.8% vs. 25.8% vs. 17.9%, P = 0.005) compared those with hypocapnia and hypercapnia respectively. In multivariable analysis, compared to normocapnia, hypocapnia [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.15-3.70] and hypercapnia (OR, 2.67; 95% CI, 1.53-4.66) were both found to be independently associated with higher rates of in-hospital mortality. Compared to normocapnia, while mild hypercapnia (OR, 2.53; 95% CI, 1.29-4.97) and moderate/severe hypercapnia (OR, 2.86; 95% CI, 1.35-6.06) were both independently associated with higher in-hospital mortality compared to normocapnia, moderate/severe hypercapnia was also independently associated with lower rates of favorable neurologic outcome (OR, 0.28; 95% CI, 0.11-0.73), while mild hypercapnia was not.
CONCLUSIONS: In this prospective registry of adults with IHCA, hypercapnia noted within 24 hours after arrest was independently associated with lower rates of survival to discharge and favorable neurologic outcome.
METHODS: The study population included 353 adults who underwent resuscitation from 2011 to 2019 for IHCA at an academic tertiary care medical center with arterial blood gas testing done within 24 hours of arrest. Outcomes of interest included survival to discharge and favorable neurologic outcome, defined as Glasgow outcome score of 4-5.
RESULTS: Of the 353 patients studied, PaCO2 classification included: hypocapnia (PaCO2 <35 mm Hg, n = 89), normocapnia (PaCO2 35-45 mm Hg, n = 151), and hypercapnia (PaCO2 >45 mm Hg, n = 113). Hypercapnic patients were further divided into mild (45 mm Hg < PaCO2 ≤55 mm Hg, n = 62) and moderate/severe hypercapnia (PaCO2 > 55 mm Hg, n = 51). Patients with normocapnia had the highest rates of survival to hospital discharge (52.3% vs. 32.6% vs. 30.1%, P < 0.001) and favorable neurologic outcome (35.8% vs. 25.8% vs. 17.9%, P = 0.005) compared those with hypocapnia and hypercapnia respectively. In multivariable analysis, compared to normocapnia, hypocapnia [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.15-3.70] and hypercapnia (OR, 2.67; 95% CI, 1.53-4.66) were both found to be independently associated with higher rates of in-hospital mortality. Compared to normocapnia, while mild hypercapnia (OR, 2.53; 95% CI, 1.29-4.97) and moderate/severe hypercapnia (OR, 2.86; 95% CI, 1.35-6.06) were both independently associated with higher in-hospital mortality compared to normocapnia, moderate/severe hypercapnia was also independently associated with lower rates of favorable neurologic outcome (OR, 0.28; 95% CI, 0.11-0.73), while mild hypercapnia was not.
CONCLUSIONS: In this prospective registry of adults with IHCA, hypercapnia noted within 24 hours after arrest was independently associated with lower rates of survival to discharge and favorable neurologic outcome.
摘要：
背景：院内心脏骤停（IHCA）仍然与高发病率和高死亡率相关。这项研究的目的是研究IHCA成人中动脉二氧化碳张力（PaCO2）与生存，出院和良好的神经系统预后的关系。
方法：研究人群包括353名成年人，他们从2011年到2021年在学术三级医疗中心接受了IHCA的复苏，并在逮捕后24小时内进行了动脉血气检测。感兴趣的结果包括生存到出院和良好的神经系统结果，定义为格拉斯哥结果得分为4-5。
结果：在研究的353名患者中，PaCO2分类包括：低碳酸血症（PaCO2<35mmg，n=89),正常碳酸血症（PaCO235-45mmHg，n=151),和高碳酸血症（PaCO2>45mmHg，n=113）。高碳酸血症患者进一步分为轻度（45mmHg55mmHg，n=51）。正常碳酸血症患者的出院生存率最高（52.3％vs32.6％vs30.1％，p<0.001）和良好的神经系统结局（35.8%vs25.8%vs17.9%，p=0.005）分别与低碳酸血症和高碳酸血症进行了比较。在多变量分析中，与normocapnia相比，低碳酸血症(OR2.06,95CI1.15~3.70)和高碳酸血症(OR2.67,95CI1.53~4.66)均与较高的住院死亡率独立相关.与正常碳酸血症相比，而轻度高碳酸血症(OR2.53,95CI1.29-4.97)和中度/重度高碳酸血症(OR2.86,95CI1.35-6.06)与正常碳酸血症相比,均与更高的住院死亡率独立相关,中度/重度高碳酸血症也与较低的有利神经系统转归率独立相关(OR0.28,95CI0.11-0.73),而轻度高碳酸血症没有。
结论：在此IHCA成人前瞻性登记中，停搏后24小时内出现的高碳酸血症与较低的出院生存率和良好的神经系统结局独立相关.
方法：研究人群包括353名成年人，他们从2011年到2021年在学术三级医疗中心接受了IHCA的复苏，并在逮捕后24小时内进行了动脉血气检测。感兴趣的结果包括生存到出院和良好的神经系统结果，定义为格拉斯哥结果得分为4-5。
结果：在研究的353名患者中，PaCO2分类包括：低碳酸血症（PaCO2<35mmg，n=89),正常碳酸血症（PaCO235-45mmHg，n=151),和高碳酸血症（PaCO2>45mmHg，n=113）。高碳酸血症患者进一步分为轻度（45mmHg
结论：在此IHCA成人前瞻性登记中，停搏后24小时内出现的高碳酸血症与较低的出院生存率和良好的神经系统结局独立相关.
