Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest.
Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest.
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DOI：
10.1371/journal.pone.0175257
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Inoue S
中科院分区：
文献类型：
--
作者：
Koami H;Sakamoto Y;Sakurai R;Ohta M;Imahase H;Yahata M;Umeka M;Miike T;Nagashima F;Iwamura T;Yamada KC;Inoue S
众所周知，在院外心脏骤停（OHCA）患者中观察到凝血功能障碍。对这些患者的溶栓治疗至今仍有争议。本研究的目的是确定一个显着的预测恢复自主循环（ROSC）的OHCA患者在急诊科（艾德）使用全血粘弹性测试。本研究入组了2013年1月至2015年12月期间在心肺复苏期间接受血栓弹性测定（ROTEM）的成人非创伤OHCA患者。我们根据是否存在ROSC将患者分为两组，并利用患者特征、院前数据、实验室数据和ROTEM数据进行统计分析。入组了75例患者。ROSC组和非ROSC组分别包括23例和52例患者。Logistic回归分析显示，乳酸水平[OR 0.880，95%CI 0.785-0.986，p = 0.028]和EXTEM试验A30 [OR 1.039，95%CI 1.010-1.070，p = 0.009]是ROSC的独立危险因素。EXTEM中乳酸和A30的截断值分别为12.0 mmol/L和A48.0 mm。如果患者的乳酸水平低于12.0 mmol/L，EXTEM的A30值高于48.0 mm，则我们定义了ROSC的阳性预测，具有高特异性（94.7%）和准确性（75.0%）。本研究表明，乳酸水平和血块硬度的ROTEM参数是OHCA成人患者艾德ED中ROSC的可靠预测因素。
It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study. We divided patients into two groups based on the presence or absence of ROSC, and performed statistical analysis utilizing patient characteristics, prehospital data, laboratory data, and ROTEM data. Seventy-five patients were enrolled. The ROSC group and non-ROSC group included 23 and 52 patients, respectively. The logistic regression analysis, utilizing significant parameters by univariate analysis, demonstrated that lactate level [odds ratio (OR) 0.880, 95% confidence interval (CI) 0.785–0.986, p = 0.028] and A30 of EXTEM test [OR 1.039, 95% CI 1.010–1.070, p = 0.009] were independent risk factors for ROSC. The cut-off values of lactate and A30 in EXTEM were 12.0 mmol/L and A 48.0 mm, respectively. We defined a positive prediction for ROSC if the patient presented lower lactate level (<12.0 mmol/L) and higher A30 of EXTEM (≥48.0 mm) with high specificity (94.7%) and accuracy (75.0%). The present study showed that lactate level and ROTEM parameter of clot firmness were reliable predictors of ROSC in the ED for adult patients with OHCA.