Impact of presenting rhythm on short- and long-term neurologic outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia.
Impact of presenting rhythm on short- and long-term neurologic outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia.
复制标题
呈现节律对接受低温治疗的心脏骤停昏迷幸存者的短期和长期神经系统结果的影响。
DOI：
10.1097/ccm.0000000000000506
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发表时间：
2014
影响因子：
8.8
通讯作者：
Silbergleit,Robert
中科院分区：
文献类型：
--
作者：
Terman,SamuelW;Hume,Benjamin;Meurer,WilliamJ;Silbergleit,Robert
目的：比较采用轻度低温治疗法治疗的院外心脏骤停昏迷幸存者的短期和长期神经功能结局，这些患者表现为不可电击与可电击的初始心律。设计：回顾性队列研究。设置：一家学术医院的急诊科和ICU。患者：2006年至2012年期间，123名连续的院外心脏骤停后成人（57例不可电击心律，66例可电击心律）接受低温治疗。干预措施：无。测量和主要结果：数据收集自电子健康记录。在出院和6- 12个月随访时，通过脑功能分类对神经功能结局进行二分，并通过多变量logistic回归进行分析。两组相似，除了非电击心律患者更可能有糖尿病史（p= 0.01）、透析依赖性（p= 0.01）和没有旁观者心肺复苏（p= 0.05）。出院时，57例不可电击心律患者中有3例（5%）与66例可电击心律患者中有28例（42%）结局良好（未校正比值比，0.08; 95%CI，0.02-0.3;校正比值比，0.1; 95%CI，0.03-0.4）。随访时，55例患者中的4例（7%）与60例患者中的29例（48%）分别具有不可电击心律和可电击心律，具有有利的脑功能分类（比值比，0.08; 95% CI，0.03-0.3;校正比值比，0.09; 95% CI，0.09-0.3）。在住院存活的患者中，两组长期随访时较出院时更可能获得良好的神经功能结局（比值比，2.5; 95%CI，1.3-4.7;校正比值比，2.9; 95%CI，1.4-6.2）。随着时间的推移，神经功能状态的变化和呈现的节奏之间没有显着的相互作用被视为（p= 0.93）。结论：这些数据表明，在轻度治疗性低温治疗的患者中，初始不可电击的节奏和显着更差的短期和长期结果之间的关联。在存活者中，所有患者和可电击心律患者的神经功能状态均随时间显著改善，少数住院后存活的不可电击心律患者的神经功能状态也随时间改善。神经系统状态随时间的变化与呈现节律之间没有显著的相互作用。
Objectives:To compare short-and long-term neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest treated with mild therapeutic hypothermia presenting with nonshockable versus shockable initial rhythms.Design:Retrospective cohort study.Setting:Emergency department and ICU of an academic hospital.Patients:One hundred twenty-three consecutive post–out-of-hospital cardiac arrest adults (57 nonshockable rhythms, 66 shockable rhythms) treated with therapeutic hypothermia between 2006 and 2012.Interventions:None.Measurements and Main Results:Data were collected from electronic health records. Neurologic outcomes were dichotomized by Cerebral Performance Category at discharge and 6-to 12-month follow-up and analyzed via multivariable logistic regressions. Groups were similar, except nonshockable rhythm patients were more likely to have a history of diabetes mellitus (p= 0.01), be dialysis dependent (p= 0.01), and not have bystander cardiopulmonary resuscitation (p= 0.05). At discharge, 3 of 57 patients (5%) with nonshockable rhythm versus 28 of 66 (42%) with shockable rhythm had a favorable outcome (unadjusted odds ratio, 0.08; 95% CI, 0.02–0.3; adjusted odds ratio, 0.1; 95% CI, 0.03–0.4). At follow-up, 4 of 55 patients (7%) versus 29 of 60 (48%) with nonshockable rhythm and shockable rhythm, respectively, had a favorable Cerebral Performance Category (odds ratio, 0.08; 95% CI, 0.03–0.3; adjusted odds ratio, 0.09; 95% CI, 0.09–0.3). Among those surviving hospitalization, favorable neurologic outcome was more likely at long-term follow-up than at hospital discharge for both groups (odds ratio, 2.5; 95% CI, 1.3–4.7; adjusted odds ratio, 2.9; 95% CI, 1.4–6.2). No significant interaction between changes in neurologic status over time and presenting rhythm was seen (p= 0.93).Conclusions:These data indicate an association between initial nonshockable rhythm and significantly worse short-and long-term outcomes in patients treated with mild therapeutic hypothermia. Among survivors, neurologic status significantly improved over time for all patients and shockable rhythm patients and tended to improve over time for the small number of nonshockable rhythm patients who survived beyond hospitalization. No significant interaction between changes in neurologic status over time and presenting rhythm was seen.