Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest
Glucocorticoid use during cardiopulmonary resuscitation may be beneficial for cardiac arrest
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DOI：
10.1016/j.ijcard.2016.08.017
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发表时间：
2016-11-01
影响因子：
3.5
通讯作者：
Chen, Wen-Jone
中科院分区：
文献类型：
--
作者：
Tsai, Min-Shan;Chuang, Po-Ya;Chen, Wen-Jone
工作背景：各种研究表明，心肺复苏（CPR）期间补充糖皮质激素，结合血管加压药，可能会改善心脏骤停的结局。然而，进一步的人口为基础的分析是必要的复苏和长期生存的好处，在这种setting.Methods管理糖皮质激素：共145，644例成人患者经历了非创伤性，心脏骤停发生在急诊室在2004-2011年期间，从台湾国民健康保险研究数据库中选择的研究。这些患者在CPR期间被分组为类固醇和非类固醇接受者，并且组成员在患者特征方面相匹配，包括提出投诉，先前类固醇使用，复苏药物和电击，治疗环境（医疗中心与否），社会经济状况和发生心脏骤停的年份，通过倾向评分。进行Logistic回归分析，以确定类固醇使用对入院生存率、出院生存率和1年生存率的影响。（n = 8628），接受类固醇治疗的患者（n = 2876）显示出明显更高的生存率入院（38.32% vs 18.67%;调整后OR = 2.97，95% CI 2.69-3.29; p < 0.0001），出院生存率（14.50% vs 5.61%;校正OR = 1.71，95% CI 1.42-2.05; p < 0.0001）和1年总生存率（10.81% vs 4.74%;校正OR = 1.48，95% CI 1.22-1.79; p < 0.0001）。在COPD或哮喘患者中，以及在CPR过程中无可电击节律的患者中，使用类固醇被证明更有益。结论：CPR过程中使用糖皮质激素与入院生存率、出院生存率和1年生存率的改善相关。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Background: Various studies have indicated that glucocorticoid supplementation during cardiopulmonary resuscitation (CPR), in conjunction with vasopressors, may improve outcomes in instances of cardiac arrest. However, further population-based analysis is warranted with respect to resuscitative and long-term survival benefits conferred by administering glucocorticoids in this setting.Methods: A total of 145,644 adult patients who experienced non-traumatic, cardiac arrest occurred at emergency room during years 2004-2011 were selected for study from the Taiwan National Health Insurance Research database. These patients were grouped as steroid and non-steroid recipients during CPR, and group members were matched in terms of patient characteristics, including presenting complaint, prior steroid use, resuscitative drugs and shocks delivered, treatment setting (medical center or not), socioeconomic status, and year that cardiac arrest occurred, through propensity scoring. Logistic regression analysis was performed to determine the impact of steroid usage on survival to admission, survival to discharge, and 1-year survival.Results: Compared with matched non-steroid group members (n = 8628), patients given steroid (n = 2876) displayed significantly higher rates of survival to admission (38.32% vs 18.67%; adjusted OR = 2.97, 95% CI 2.69-3.29; p < 0.0001), survival to discharge (14.50% vs 5.61%; adjusted OR = 1.71, 95% CI 1.42-2.05; p < 0.0001), and 1-year overall survival (10.81% vs 4.74%; adjusted OR = 1.48, 95% CI 1.22-1.79; p < 0.0001). Steroid use proved more beneficial in patients with COPD or asthma and in the absence of shockable rhythmduring CPR.Conclusion: Glucocorticoid use during CPR is associated with improved survival-to-admission, survival-to-discharge, and 1-year survival rates. (C) 2016 Elsevier Ireland Ltd. All rights reserved.