Factors associated with a change in functional outcome between one month and six months after cardiac arrest A retrospective cohort study
Factors associated with a change in functional outcome between one month and six months after cardiac arrest A retrospective cohort study
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DOI：
10.1016/j.resuscitation.2009.04.045
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发表时间：
2009-08-01
期刊：
影响因子：
6.5
通讯作者：
Herkner, Harald
中科院分区：
文献类型：
--
作者：
Arrich, Jasmin;Zeiner, Andrea;Herkner, Harald
研究目的：评估心脏骤停幸存者功能结局的适当时间点仍然是一个有争议的问题。在这项队列研究中，我们提出了一个假设，即在院外心脏骤停后一个月到六个月之间，脑功能类别(CPC)没有显着变化。如果存在变化，我们的目的是确定这些变化的原因。方法：基于心脏骤停登记，分析心脏骤停后1个月至6个月之间CPC和死亡率的潜在变化。结果：在681例患者中，30%的患者在院外心脏骤停后1个月至6个月的功能结局和死亡率有显著变化，12%的患者CPC改善，1%的患者恶化，17%的患者死亡。在多因素分析中，与CPC改善相关的唯一因素是自主循环恢复时间(ROSC)(RRR 1.04，95%CI 1.01-1.06，每分钟)。我们没有发现任何与CPC恶化相关的显著因素。与病死率相关的因素有年龄(RRR 1.03，95%CI 1.01~1.06)和以室颤为初始心律(RRR 0.34，95%CI 0.16~0.71)。结论：即使在院外心脏骤停后1个月，心功能也有相应的变化。特别是当研究比较停搏时间不相等、初始心律分布不均匀的患者组时，应考虑将超过一个月的随访期作为心脏骤停后的最终结果评估。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Aim of the study: The appropriate time point of evaluation of functional outcome in cardiac arrest survivors remains a matter of debate. In this cohort study we posed the hypothesis that there are no significant changes in Cerebral Performance Categories (CPC) between one month and six months after out-of hospital cardiac arrest. If changes were present we aimed to identify reasons for these changes.Methods: Based on a cardiac arrest registry, a potential change in CPC and mortality between one month and six months after cardiac arrest was analysed. Variables that were associated with these changes were identified.Results: Thirty percent of 681 patients showed a significant change in functional outcome and mortality between one month and six months after out-of hospital cardiac arrest, 12% improved in CPC, 1% deteriorated, 17% died. The only factor that was associated with an improvement in CPC in the multivariate analysis was time to restoration of spontaneous circulation (ROSC) (RRR 1.04, 95% Cl 1.01-1.06, per minute). We could not find any significant factors associated with a deterioration of CPC. Factors that were associated with mortality were age (RRR 1.03,95% Cl 1.01-1.06) and ventricular fibrillation as initial cardiac rhythm (RRR 0.34, 95% Cl 0.16-0.71).Conclusions: There is a relevant change of functional outcome even one month after out-of hospital cardiac arrest. Especially when studies compare patient groups with unequal arrest times, and an unequal distribution of initial cardiac rhythms a follow-up period longer than one month should be considered for the final outcome evaluation after cardiac arrest. (C) 2009 Elsevier Ireland Ltd. All rights reserved.