Cardiac arrests and deaths associated with malignant hyperthermia in North America from 1987 to 2006 - A report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States
Cardiac arrests and deaths associated with malignant hyperthermia in North America from 1987 to 2006 - A report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States
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DOI：
10.1097/aln.0b013e318167aee2
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发表时间：
2008-04-01
期刊：
影响因子：
8.8
通讯作者：
Lehman, Erik B.
中科院分区：
文献类型：
--
作者：
Larach, Marilyn Green;Brandom, Barbara W.;Lehman, Erik B.
背景资料：作者确定了北美恶性高热（MH）登记处报告的加拿大和美国病例的相关心脏骤停和死亡率，并分析了与不良结局风险较高相关的因素。（对麻醉的不良代谢/肌肉骨骼反应）报告，入选标准如下：事件发生日期在1987年1月1日至2006年12月31日之间;根据MH临床分级量表，“非常可能”或“几乎确定”MH;地点在加拿大或美国;给予一种或多种麻醉剂。排除标准是作者独立判断的除MH以外的病理状况。分析重度MH结局的临床病史和表现，连续变量采用Wilcoxon秩和检验，分类变量采用Pearson精确卡方检验。A Bonferroni校正调整多重comparation.Results：291事件，8（2.7%）导致心脏骤停和4（1.4%）导致死亡。心脏骤停/死亡病例的中位年龄为20岁（范围，2-31岁）。相关因素包括肌肉发达（优势比，18.7; P = 0.0016）和弥漫性血管内凝血（优势比，49.7; P < 0.0001）。心脏骤停/死亡的风险增加与麻醉诱导和最大呼气末二氧化碳之间的时间较长有关（216 vs. 87 min; P = 0.003）。不相关的因素包括患者或家族史，麻醉管理，和MH epission.Conclusions：现代美国麻醉的做法并没有防止MH相关的心脏骤停和死亡，主要是年轻，健康的患者进行低至中等风险的外科手术。
Background: The authors determined associated cardiac arrest and death rates in cases from Canada and the United States as reported to The North American Malignant Hyperthermia (MH) Registry and analyzed factors associated with a higher risk of poor outcomes.Methods: The authors searched the database for AMRA (adverse metabolic/musculoskeletal reaction to anesthesia) reports with inclusion criteria as follows: event date between January 1, 1987, and December 31, 2006; "very likely" or "almost certain" MH as ranked by MH Clinical Grading Scale; location in Canada or die United States; and one or more anesthetic agents given. The exclusion criterion was a pathologic condition other than MH independently judged by the authors. Severe MH outcomes were analyzed as regards clinical history and presentation, using Wilcoxon rank sum tests for continuous variables and Pearson exact chi-square tests for categorical variables. A Bonferroni correction adjusted for multiple comparisons.Results: Of 291 events, 8 (2.7%) resulted in cardiac arrests and 4 (1.4%) resulted in death. The median age in cases of cardiac arrest/death was 20 yr (range, 2-31 yr). Associated factors were muscular build (odds ratio, 18.7; P = 0.0016) and disseminated intravascular coagulation (odds ratio, 49.7; P < 0.0001). Increased risk of cardiac arrest/death was related to a longer time period between anesthetic induction and maximum end-tidal carbon dioxide (216 vs. 87 min; P = 0.003). Unrelated factors included patient or family history, anesthetic management, and the MH episode.Conclusions: Modern US anesthetic practice did not prevent MH-associated cardiac arrest and death in predominantly young, healthy patients undergoing low- to intermediate-risk surgical procedures.