Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia
Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia
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DOI：
10.1097/ccm.0b013e3181fa4301
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发表时间：
2011-01-01
影响因子：
8.8
通讯作者：
Friberg, Hans
中科院分区：
文献类型：
--
作者：
Nielsen, Niklas;Sunde, Kjetil;Friberg, Hans
目的：调查重症监护期间记录的不良事件与接受治疗性低温治疗的院外心脏骤停患者死亡率之间的相关性。设计：前瞻性、观察性、基于登记的研究。设置：欧洲和美国的22家医院。患者：2004年10月至2008年10月，纳入765例患者。干预：无。测量和主要结果：心律失常（7%-14%）、肺炎（48%）、代谢和电解质紊乱（5%-37%）和癫痫发作（24%）是接受治疗性低温治疗的心脏骤停患者在重症监护期间的常见不良事件，而败血症（4%）和出血（6%）的发生率较低。在多变量模型中，持续高血糖（血糖>8 mmol/L，持续时间>4小时;比值比2.3，95%置信区间1.6-3.6，p <0.001）和抗惊厥药治疗癫痫发作（比值比4.8，95%置信区间2.9-8.1，p <0.001）与死亡率增加相关。侵入性操作后出血和脓毒症的发生频率增加（冠状动脉造影、血管内降温装置、主动脉内球囊反搏），但出血和败血症与死亡率增加无关（比值比1.0，95%置信区间0.46-2.2，p = 0.91，比值比0.30，95%置信区间0.12-0.79，p = 0.01）。不良事件在院外心脏骤停后很常见。持续高血糖和癫痫发作与抗惊厥药物治疗的死亡率增加有关。出血和感染在侵入性手术后更常见，但在我们的研究中，这些不良事件与死亡率增加无关。(Crit Care Med 2011; 39：57-64）
Objectives: To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.Design: Prospective, observational, registry-based study.Setting: Twenty-two hospitals in Europe and the United States.Patients: Between October 2004 and October 2008, 765 patients were included.Interventions: None.Measurements and Main Results: Arrhythmias (7%-14%), pneumonia (48%), metabolic and electrolyte disorders (5%-37%), and seizures (24%) were common adverse events in the critical care period in cardiac arrest patients treated with therapeutic hypothermia, whereas sepsis (4%) and bleeding (6%) were less frequent. Sustained hyperglycemia (blood glucose >8 mmol/L for >4 hrs; odds ratio 2.3, 95% confidence interval 1.6-3.6, p < .001) and seizures treated with anticonvulsants (odds ratio 4.8, 95% confidence interval 2.9-8.1, p < .001) were associated with increased mortality in a multivariate model. An increased frequency of bleeding and sepsis occurred after invasive procedures (coronary angiography, intravascular devices for cooling, intra-aortic balloon pump), but bleeding and sepsis were not associated with increased mortality (odds ratio 1.0, 95% confidence interval 0.46-2.2, p = .91, and odds ratio 0.30, 95% confidence interval 0.12-0.79, p = .01, respectively).Conclusions: Adverse events were common after out-of-hospital cardiac arrest. Sustained hyperglycemia and seizures treated with anticonvulsants were associated with increased mortality. Bleeding and infection were more common after invasive procedures, but these adverse events were not associated with increased mortality in our study. (Crit Care Med 2011; 39:57-64)