Effects of pre-arrest comorbidities on 90-day survival of patients resuscitated from out-of-hospital cardiac arrest
Effects of pre-arrest comorbidities on 90-day survival of patients resuscitated from out-of-hospital cardiac arrest
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DOI：
10.1136/emj.2009.087593
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发表时间：
2011-05-01
影响因子：
3.1
通讯作者：
Chen, Shyr-Chyr
中科院分区：
文献类型：
--
作者：
Lee, Chien-Chang;Tsai, Min-Shan;Chen, Shyr-Chyr
背景影响重症监护病房(ICU)院外心肺骤停患者复苏后最初24小时存活的预后因素尚未确定。本研究旨在评估成功从OHCA复苏的患者90天存活期的临床预后因素。对224例非创伤性心肺复苏患者的临床资料进行单因素和多因素分析，发现与90天存活相关的独立因素包括：肝硬变(HR 4.36，95%CI 1.76~10.79)、心肺复苏时间延长(HR 1.95，95%CI 1.27~3.00)和潜在恶性肿瘤(HR 1.64，95%CI 1.06~2.54)。影响预后的因素包括自主循环恢复后24~48h内格拉斯哥昏迷评分(HR 0.16，95%CI 0.04~0.68)、入院时平均动脉压(HR 0.81，95%CI 0.43~0.94)和无脉搏电节律(HR 0.44，95%CI 0.1~0.63)。合并症的高负担(按Charlson Score>；5)与显著较差的90天生存相关(HR 1.60，95%CI 1.03至2.49)。结论潜在的合并症对生存有显著影响。心肺复苏时间、复苏后血压和早期神经功能恢复可作为短期生存的实用临床预测指标。
Background Factors that affect prognosis in successfully resuscitated out-of-hospital cardiopulmonary arrest (OHCA) patients in the intensive care unit (ICU) who survived the initial 24 h period of post-resuscitation have not been established. This study was conducted to evaluate the clinical prognostic factors associated with 90-day survival in patients who were successfully resuscitated from OHCA.Methods This study was conducted at a tertiary large university hospital. Clinical data were obtained from the medical records of 224 adult non-traumatic patients who were successfully resuscitated from OHCA and who survived the initial 24 h post-resuscitation phase.Univariate and multivariate analyses were performed to identify independent predictors associated with 90-day survival.Results Significant adverse prognosticators included liver cirrhosis (HR 4.36, 95% CI 1.76 to 10.79), prolonged cardiopulmonary resuscitation (CPR) duration >20 min (HR 1.95, 95% CI 1.27 to 3.00) and underlying malignancy (HR 1.64, 95% CI 1.06 to 2.54). Favourable prognostic factors included the best Glasgow Coma Scale within 24-48 h after return of spontaneous circulation >5 (HR 0.16, 95% CI 0.04 to 0.68), mean arterial pressure on ICU admission >100 mmHg (HR 0.81, 95% CI 0.43 to 0.94) and the presenting rhythm of pulseless electrical activity (HR 0.44, 95% CI 0.1 to 0.63). A high burden of comorbidities (by Charlson score >5) was associated with significantly poorer 90-day survival (HR 1.60, 95% CI 1.03 to 2.49).Conclusions Underlying comorbidities have a significant influence on survival. CPR duration, post-resuscitative blood pressure and early neurological recovery may serve as practical clinical predictors of short-term survival.