Lower heart rate is associated with good one-year outcome in post-resuscitation patients
Lower heart rate is associated with good one-year outcome in post-resuscitation patients
复制标题
DOI：
10.1016/j.resuscitation.2018.05.001
复制
发表时间：
2018-07-01
期刊：
影响因子：
6.5
通讯作者：
Wilkman, Erika
中科院分区：
文献类型：
--
作者：
Oksanen, Tuomas;Tiainen, Marjaana;Wilkman, Erika
背景：复苏后患者的最佳血流动力学目标尚不清楚。以前的研究已经报道了院外心脏骤停后接受靶向体温管理(TTM)的患者心率较低与良好预后之间的关系。方法：我们分析了来自FINNRESUSCI研究前瞻性收集的数据库中的504名复苏后患者的心率(HR)和预后数据。结果：504例患者中，神经功能恢复良好者占40.1%(202/504)，差者占59.9%(302/504)。预后良好的患者在ICU的前48小时(69.2次/分[59.2-75.1次/分]比76.6次/分[65.72-89.6次/分]，p<；0.001)和前72小时(71.2次/分[65.0-79.0次]比77.1次/分[69.1-90.1次/分，p<；0.001]的时间加权平均心率较低。在HR阈值(60、80和100次/分)以下的HR登记的百分比在神经系统预后良好的患者中更高，P<；0.001。0-48 h和0-72 h的时间加权HR较低，HR记录低于阈值的百分比较高，独立地与良好的神经学一年结果相关(p<；0.05)。当分别分析TTM患者和非TTM患者时，HR参数仅在非TTM患者中与一年的神经预后独立相关。结论：较低的心率与良好的神经预后独立相关。复苏后患者的心率是预后指标还是治疗靶向的重要变量，需要在未来的前瞻性对照临床试验中进行评估。
Background: Optimal hemodynamic goals in post-resuscitation patients are not clear. Previous studies have reported an association between lower heart rate and good outcome in patients receiving targeted temperature management (TTM) after out-of-hospital cardiac arrest.Methods: We analyzed heart rate (HR) and outcome data of 504 post-resuscitation patients from the prospectively collected database of the FINNRESUSCI study. One-year neurologic outcome was dichotomized by the Cerebral Performance Category (CPC) to good (1-2) or poor (3-5).Results: Of 504 patients, 40.1% (202/504) had good and 59.9% (302/504) had poor one-year neurologic outcome. Patients with good outcome had lower time-weighted mean HR during the first 48 h in the ICU (69.2 bpm [59.2-75.1] vs. 76.6 bpm [65.72-89.6], p < 0.001) and the first 72 h in the ICU (71.2 bpm [65.0-79.0] vs. 77.1 bpm [69.1-90.1, p < 0.001]). The percentage of HR registrations below HR threshold values (60, 80 and 100 bpm) were higher for patients with good neurologic outcome, p < 0.001 for all. Lower time-weighted HR for 0-48 h and 0-72 h, and a higher percentage of HR recordings below threshold values were independently associated with good neurological one-year outcome (p < 0.05 for all). When TTM and non-TTM patients were analyzed separately, HR parameters were independently associated with one-year neurologic outcome only in non-TTM patients.Conclusion: Lower heart rate was independently associated with good neurologic outcome. Whether HR in post-resuscitation patients is a prognostic indicator or an important variable to be targeted by treatment, needs to be assessed in future prospective controlled clinical trials.