Multicenter cohort study of out-of-hospital pediatric cardiac arrest.
Multicenter cohort study of out-of-hospital pediatric cardiac arrest.
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DOI：
10.1097/ccm.0b013e3181fa3c17
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发表时间：
2011-01
影响因子：
8.8
通讯作者：
Pediatric Emergency Care Applied Research Network
中科院分区：
文献类型：
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作者：
Moler FW;Donaldson AE;Meert K;Brilli RJ;Nadkarni V;Shaffner DH;Schleien CL;Clark RS;Dalton HJ;Statler K;Tieves KS;Hackbarth R;Pretzlaff R;van der Jagt EW;Pineda J;Hernan L;Dean JM;Pediatric Emergency Care Applied Research Network
描述一大批院外(OH)心脏骤停并恢复循环(ROC)的儿童，并确定与存活相关的早期心脏骤停后因素。这些目标是为了规划一项儿童心脏骤停后治疗性低温的干预性试验。在18个月的研究期间，在15个儿科急救应用研究网络(PECARN)临床站点进行了一项回溯性队列研究。所有年龄在24小时到18岁之间、心跳骤停且有至少1分钟的胸部按压且有至少20分钟的ROC病史的儿童均符合条件。138例符合纳入标准，总死亡率为62%(85/138)。与存活率增加相关的事件特征如下：周末被捕，入院时未进行心肺复苏，停搏节律而不是心跳停止，没有阿托品或碳酸氢钠，肾上腺素剂量较少，CPR持续时间较短，以及溺水或窒息停搏事件。在ROC术后0-12小时内，未使用任何血管升压剂或正性肌力药(多巴胺、肾上腺素)、较高的最低体温、较高的最低pH、较低的乳酸、较低的最高血糖和正常的瞳孔反应均与生存有关。停搏时可用变量的多变量Logistic模型控制了性别、年龄、种族、停搏或室颤/室性心动过速(VF/VT)，发现阿托品和肾上腺素的应用与死亡率有关。第二个模型使用可在ROC后12小时内获得的额外信息，发现1)既往存在的肺部或呼吸道疾病，2)窒息或溺水的病因，3)较高的PH值和4)双眼反应性瞳孔与较低的死亡率相关。在96%(44/46)的病例中，超过3剂肾上腺素的患者预后不佳。多个因素被证实与儿童心脏骤停后的存活有关。ROC后几小时内可获得的额外信息可能会减少回归模型中较早时间可用因素的结果相关性。在设计未来旨在改善儿科心脏骤停后预后的介入试验时，应考虑这些因素。
To describe a large cohort of children with out-of-hospital (OH) cardiac arrest with return of circulation (ROC) and to identify factors in the early post-arrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network (PECARN) clinical sites over an 18 month study period. All children 24 hours to 18 years of age with OH cardiac arrest and a history of at least 1 minute of chest compressions with ROC for at least 20 minutes were eligible. 138 cases met study entry criteria; the overall mortality was 62% (85/138). Event characteristics associated with increased survival were the following: weekend arrests, CPR not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of CPR, and drowning or asphyxial arrest event. For the 0–12 hour post-arrest ROC period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, asystole or ventricular fibrillation/ventricular tachycardia (VF/VT) anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hours post ROC found 1) preexisting lung or airway disease, 2) etiology of arrest drowning or asphyxia, 3) higher pH and 4) bilateral reactive pupils to be associated with lower mortality. More than 3 doses of epinephrine were associated with poor outcome in 96% (44/46) of cases. Multiple factors were identified to be associated with survival after OH pediatric cardiac arrest with ROC. Additional information available within a few hours after ROC may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.