Intra-arrest partial carbon dioxide level and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry)
Intra-arrest partial carbon dioxide level and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry)
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院外心脏骤停后心脏骤停期间的部分二氧化碳水平和良好的神经系统结果：日本的一项全国性多中心观察性研究（JAAM-OHCA 注册中心）
DOI：
10.1093/ehjacc/zuac152
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kitamura Tetsuhisa
中科院分区：
文献类型：
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作者：
Matsuyama Tasuku;Ohta Bon;Kiyohara Kosuke;Kitamura Tetsuhisa
心肺复苏期间指南推荐的通气是否会导致最佳的部分二氧化碳（pCO 2）水平或有利的结果，目前还知之甚少。本研究旨在评估院外心脏骤停（OHCA）后停搏时pCO 2水平与预后之间的关系。方法和结果我们对一项多中心观察性研究进行了二次分析，包括未恢复自主循环（ROSC）的OHCA成人患者在2014年6月至2017年12月期间，在ROSC之前进行了血气分析。根据停搏期间二氧化碳水平，将患者分为四个四分位数：四分位数1（<66.0 mmHg）、四分位数2（66.1-87.2 mmHg）、四分位数3（87.3-113.5 mmHg）和四分位数4（≥113.6 mmHg）。主要结局为1个月生存率，神经功能结局良好定义为脑功能1级或2级。采用多变量logistic回归分析评价pCO 2与良好神经功能结局之间的相关性。在研究期间，20913例患者有资格进行分析。在四分位数1-4中，有利的神经系统结局比例分别为1.8%（90/5133）、0.7%（35/5232）、0.4%（19/5263）和0.2%（9/5285）。多因素Logistic回归分析显示，随着术中二氧化碳浓度的升高，神经功能预后良好的概率降低（即Q1 vs.Q4，校正比值比0.25，95%可信区间0.16- 0.55，P <0.001）。
AimsLittle is known about whether guideline-recommended ventilation during cardiopulmonary resuscitation results in optimal partial carbon dioxide (pCO2) levels or favorable outcomes. This study aimed to evaluate the association between intra-arrest pCO2level and the outcome after out-of-hospital cardiac arrest (OHCA).Methods and resultsWe performed a secondary analysis of a multicenter observational study, including adult patients with OHCA who did not achieve a return of spontaneous circulation (ROSC) upon hospital arrival and whose blood gas analysis was performed before the ROSC between June 2014 and December 2017. The patients were categorized into four quartiles based on their intra-arrest carbon dioxide levels: Quartile 1 (<66.0 mmHg), Quartile 2 (66.1–87.2 mmHg), Quartile 3 (87.3–113.5 mmHg), and Quartile 4 (≥113.6 mmHg). The primary outcome was 1-month survival with favorable neurological outcomes defined as cerebral performance Category 1 or 2. Multivariate logistic regression analysis was used to evaluate the association between pCO2and favorable neurological outcomes. During the study period, 20 913 patients were eligible for the analysis. The proportion of favorable neurological outcomes was 1.8% (90/5133), 0.7% (35/5232), 0.4% (19/5263), and 0.2% (9/5285) in Quartiles 1–4, respectively. Multivariable logistic regression analysis demonstrated that the probability of favorable neurological outcome decreased with increased intra-arrest carbon dioxide levels (i.e. Q1 vs. Q4, adjusted odds ratio 0.25, 95% confidence interval 0.16–0.55,Pfor trend <0.001).ConclusionLower intra-arrest pCO2levels were associated with a favorable neurological outcome.