Outcome following cardiopulmonary resuscitation in the neonate requiring ventilatory assistance
Outcome following cardiopulmonary resuscitation in the neonate requiring ventilatory assistance
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DOI：
10.1016/s0300-9572(00)00184-2
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发表时间：
2000-08-01
期刊：
影响因子：
6.5
通讯作者：
Perlman, JM
中科院分区：
文献类型：
--
作者：
Chamnanvanakij, S;Perlman, JM
背景资料：关于发生需要心肺复苏（CPR）的持续性心动过缓（PB）的需要急救的新生儿的临床特征和结果的数据有限。目的：（1）确定需要呼吸辅助的新生儿发生PB并需要CPR作为复苏的一部分的百分比;（2）相关的临床事件;（3）短期结局。研究方法：回顾性分析了新生儿重症监护室收治的患有PB（定义为心率< 80次/分，需要CPR）的婴儿的病历。结果3年来，1485名婴儿中有39名（2.6%）表现出62次需要CPR的PB发作;这代表695名插管婴儿的5.6%。14例（36%）婴儿对胸外按压反应迅速，仅在2分钟内恢复心率;称为简短CPR。没有人在医院死亡。25名（64%）婴儿需要延长胸外按压，即> 2分钟（称为延长CPR）; 21名婴儿还接受了肾上腺素治疗。CPR发生时的中位出生后年龄为20天（范围1-148天），CPR持续时间为10分钟（范围3-73分钟）。可能导致PB的更常见医学状况包括与慢性肺病（CLD）相关的重度支气管痉挛（n = 6）、与脓毒症相关的休克（n = 4）和坏死性小肠结肠炎（NEC）（n = 2）、气胸（n = 2）、通气不足或不当（n = 3）、其他（n = 8）。19名（76%）婴儿死亡：13名在事件发生后24小时内死亡，6名在心肺复苏术后3至194天死亡。在18个月的随访中，6名接受评估的婴儿中有4名患有中度至重度神经发育缺陷。在接受评估的9名需要简短心肺复苏术的婴儿中，5名发育正常，4名有中度至重度神经发育缺陷。结论：新生儿心肺复苏需要急救的情况并不少见。当时间短暂时，死亡率较低，短期结局可能由基础医学状况决定。当CPR延长时，死亡率很高，短期结果很差。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Background: there is limited data regarding the clinical characteristics and outcome of the neonate requiring ventilatory assistance who develops persistent bradycardia (PB) requiring cardiopulmonary resuscitation (CPR). Objectives: (1) to determine the percentage of newborn infants requiring respiratory assistance who develop PB and require CPR as part of resuscitation; (2) the associated clinical events; and (3) the short term outcome. Methods: the medical charts of infants admitted to a neonatal intensive care unit who developed PB, defined as a heart rate < 80 beats/min requiring CPR, were retrospectively reviewed. Results. for 3 years, 39 (2.6%) of 1485 infants exhibited 62 episodes of PB requiring CPR; this represents 5.6% of 695 intubated infants. Fourteen (36%) infants rapidly responded to chest compressions only with restoration of heart rate within 2 min; termed brief CPR. None died in-hospital. Twenty-five (64%) infants required prolonged chest compressions, i.e. > 2 min (termed prolonged CPR); 21 also received epinephrine. The median postnatal age at onset of CPR was 20 days (range 1-148 days) and the duration of CPR was 10 min (range 3-73 min). The more common medical conditions that may have contributed to the PB included severe bronchospasm associated with chronic lung disease (CLD) (n = 6), shock associated with sepsis (n = 4) and necrotizing enterocolitis (NEC) (n = 2), pneumothorax (n = 2), inadequate or improper ventilation (n = 3), other (n = 8). Nineteen (76%) infants died: 13 within 24 h of the event and six from 3 to 194 days following CPR. At 18 months follow-up, four of the six infants evaluated have a moderate to severe neurodevelopmental deficit. Of the nine infants requiring brief CPR who were evaluated, five are developing normally and four have a moderate to severe neurodevelopmental deficit. Conclusion: CPR in the neonate who requires ventilatory assistance is not uncommon. When brief in nature, mortality is low and short-term outcome is likely to be determined by the underlying medical condition. When CPR is prolonged, mortality is high and short-term outcome is poor. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.