Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality.
Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality.
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DOI：
10.1016/j.resuscitation.2008.07.019
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发表时间：
2008-12
期刊：
影响因子：
6.5
通讯作者：
Trzeciak, Stephen
中科院分区：
文献类型：
--
作者：
Kilgannon, J. Hope;Roberts, Brian W.;Reihl, Lisa R.;Chansky, Michael E.;Jones, Alan E.;Dellinger, R. Phillip;Parrillo, Joseph E.;Trzeciak, Stephen
关键词：
心脏骤停恢复自然循环（ROSC）后，深度心肌休克和全身炎症可引起血流动力学改变；然而，rosc后血流动力学不稳定的患病率及其与预后的关联程度尚未确定。我们验证了ROSC后暴露于动脉低血压通常发生（>50%）的假设，并且是死亡的独立预测因子。一年内所有心脏骤停后患者的单中心回顾性队列研究。入选标准：(1)年龄≥17岁；(2) non-trauma;(3)心脏骤停后持续ROSC。使用Jones标准，受试者根据ROSC后6小时内是否存在低血压分为两组：(1)暴露-两次或两次以上收缩压(SBP) < 100mmhg或(2)非暴露-小于两次收缩压< 100mmhg。主要终点是住院死亡率。我们比较了两组之间的死亡率，并使用多变量逻辑回归来确定rosc后低血压是否独立预测死亡。102名受试者符合纳入标准。住院死亡率为75%。低血压暴露的发生率为66/102(65%)，死亡率（83%）明显高于未暴露的死亡率（58%,p=0.01）。在控制常见混杂变量（年龄、骤停前功能状态、骤停节律和提供治疗性低温）的模型中，早期暴露于低血压是死亡的一个强有力的独立预测因子（OR 3.5 [95% CI 1.3-9.6]）。ROSC后早期暴露于动脉低血压是常见的，也是死亡的独立预测因子。这些数据表明，rosc后低血压可能是心脏骤停后护理的潜在治疗靶点。
After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death. Single-center retrospective cohort study of all post-cardiac arrest patients over one year. Inclusion criteria: (1) age >17; (2) non-trauma; (3) sustained ROSC after cardiac arrest. Using the Jones criteria, subjects were assigned to one of two groups based on the presence of hypotension within 6 hours after ROSC: (1) Exposures – two or more systolic blood pressures (SBP) <100 mmHg or (2) Non-exposures – less than two SBP <100 mmHg. The primary outcome was in-hospital mortality. We compared mortality rates between groups and used multivariate logistic regression to determine if post-ROSC hypotension independently predicted death. 102 subjects met inclusion criteria. In-hospital mortality was 75%. Exposure to hypotension occurred in 66/102 (65%) and was associated with significantly higher mortality (83%) compared to non-exposures (58%, p=0.01). In a model controlling for common confounding variables (age, pre-arrest functional status, arrest rhythm, and provision of therapeutic hypothermia), early exposure to hypotension was a strong independent predictor of death (OR 3.5 [95% CI 1.3–9.6]). Early exposure to arterial hypotension after ROSC was common and an independent predictor of death. These data suggest that post-ROSC hypotension could potentially represent a therapeutic target in post-cardiac arrest care.
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