探讨ICU成年患者心脏骤停后的死亡率和神经功能的预测因素。
进行了前瞻性队列多中心研究。
46个多价ICU。
共有595名患者从院外心脏骤停中恢复(OHCA,n=285)或院内心脏骤停(IHCA,n=310)。
神经功能的存活和恢复。
平均心肺复苏时间为18分钟(范围10-30)。197例患者使用了中度低温,150例接受经皮冠状动脉介入治疗(PCI)。370例患者在20min内恢复了自主循环(ROSC)。与死亡率相关的变量(ICU和住院)是年龄(比值比[OR]=1.0,每年95CI1.0-1.0),非心脏原因的心脏骤停(OR=2.16,95CI1.38-3.38;P=0.001)和ROSC>20min(OR=3.07,95CI1.97-4.78;P<0.001),而PCI和可电击节律的存在表现出保护作用。有利的神经系统结果与可电击节律有关,ROSC<20min,和心脏骤停的起源。在多变量分析中,低体温不影响生存或神经系统结果。
年龄,非心脏原因的心脏骤停和ROSC>20分钟是死亡率的预测因素.相比之下,心脏起源的心脏骤停,ROSC<20min,和可除颤节律与不利的神经系统结局相关。
To identify predictors of mortality and neurological function in adult ICU patients recovering from cardiac arrest.
A prospective cohort multicenter study was carried out.
Forty-six polyvalent ICUs.
A total of 595 patients recovering from out-of-hospital cardiac arrest (OHCA, n=285) or in-hospital cardiac arrest (IHCA, n=310).
Survival and recovery of neurological function.
The mean cardiopulmonary resuscitation time was 18min (range 10-30). Moderate hypothermia was used in 197 patients, and 150 underwent percutaneous coronary intervention (PCI). Return of spontaneous circulation (ROSC) was achieved within 20min in 370 patients. Variables associated to mortality (ICU and in-hospital) were age (odds ratio [OR]=1.0, 95%CI 1.0-1.0 per year), non-cardiac origin of cardiac arrest (OR=2.16, 95%CI 1.38-3.38; P=0.001) and ROSC >20min (OR=3.07, 95%CI 1.97-4.78; P<0.001), whereas PCI and the presence of shockable rhythm exhibited a protective effect. Favorable neurological outcome was associated to shockable rhythm, ROSC <20min, and cardiac origin of arrest. Hypothermia did not affect survival or neurological outcome in the multivariate analysis.
Age, non-cardiac origin of cardiac arrest and ROSC >20min were predictors of mortality. In contrast, cardiac arrest of cardiac origin, ROSC <20min, and defibrillable rhythms were associated to unfavorable neurological outcomes.