Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study
Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study
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DOI：
10.1016/j.resuscitation.2015.03.016
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发表时间：
2015-06-01
期刊：
影响因子：
6.5
通讯作者：
Dens, J.
中科院分区：
文献类型：
--
作者：
Ameloot, K.;Meex, I.;Dens, J.
目的：与脓毒症类似，目前的心脏骤停（CA）指南建议将平均动脉压（MAP）高于65 mmHg和SVO2高于70%作为目标。死亡率或脑灌注数据不支持这一观点。本研究旨在探讨MAP、SVO2、脑氧合与生存之间的关系。方法：采用近红外光谱法对82例ca后患者进行低温治疗（24小时- 33℃）期间的前瞻性观察研究。结果：43例患者（52%）在CPC 1-2至ca后180天存活。与最大生存相关的平均MAP范围为76-86 mmHg （OR 2.63, 95% CI [1.01; 6.88], p = 0.04）。与最大生存率相关的平均SVO2范围为67-72% （OR 8.23, 95% CI [2.07; 32.68], p = 0.001）。在两个独立的多变量模型中，最佳范围内的平均MAP （OR 3.72, 95% CI [1.11; 12.50], p = 0.03）和平均SVO2 （OR 10.32, 95% CI [2.03; 52.60], p = 0.001）与生存率的增加独立相关。基于超过1 62.5万的数据点，我们发现SVO2（范围40-90%）与平均脑饱和度（R-2 0.86）和MAP与平均脑饱和度（R-2 0.83）之间存在很强的线性关系。根据我们的血流动力学模型，MAP和SVO2与最佳脑氧合相关的范围分别为87-101 mmHg和70-75%。结论：我们发现MAP范围在76-86 mmHg之间，SVO2范围在67% - 72%之间与最大生存相关。最佳脑饱和度为MAP在87-101 mmHg之间，SVO2在70% - 75%之间。需要前瞻性的介入研究来调查在额外的药物支持下，在建议的范围内强制MAP和SVO2是否会改善结果。2015爱思唯尔爱尔兰有限公司版权所有。
Aim: In analogy with sepsis, current post-cardiac arrest (CA) guidelines recommend to target mean arterial pressure (MAP) above 65 mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. The aim of this study was to explore the associations between MAP, SVO2, cerebral oxygenation and survival.Methods: Prospective, observational study during therapeutic hypothermia (24 h - 33 degrees C) in 82 post-CA patients monitored with near-infrared spectroscopy.Results: Forty-three patients (52%) survived in CPC 1-2 until 180 days post-CA. The mean MAP range associated with maximal survival was 76-86 mmHg (OR 2.63, 95% CI [1.01; 6.88], p = 0.04). The mean SVO2 range associated with maximal survival was 67-72% (OR 8.23, 95% CI [2.07; 32.68], p = 0.001). In two separate multivariate models, a mean MAP (OR 3.72, 95% CI [1.11; 12.50], p = 0.03) and a mean SVO2 (OR 10.32, 95% CI [2.03; 52.60], p = 0.001) in the optimal range persisted as independently associated with increased survival. Based on more than 1 625 000 data points, we found a strong linear relation between SVO2 (range 40-90%) and average cerebral saturation (R-2 0.86) and between MAP and average cerebral saturation for MAP's between 45 and 101 mmHg (R-2 0.83). Based on our hemodynamic model, the MAP and SVO2 ranges associated with optimal cerebral oxygenation were determined to be 87-101 mmHg and 70-75%.Conclusion: we showed that a MAP range between 76-86 mmHg and SVO2 range between 67% and 72% were associated with maximal survival. Optimal cerebral saturation was achieved with a MAP between 87-101 mmHg and a SVO2 between 70% and 75%. Prospective interventional studies are needed to investigate whether forcing MAP and SVO2 in the suggested range with additional pharmacological support would improve outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.