Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes inpost-cardiac arrest care with targeted temperature management.

目標體溫管理的心肺複蘇後的患者血流動力學變量與院內死亡率及良好神經預後的關係

PURPOSE

Although hemodynamic instability is expected during thepost-cardiac arrest period, the implications of hemodynamic parameters for outcomes remain unclear. Each phase of targeted temperature management (TTM) affects hemodynamic responses differently. This study aims to investigate the association of hemodynamic parameters with outcomes in patients receiving TTM after cardiac arrest.

目的：雖然心髒驟停複蘇後常會出現血流動力學不穩定，但血流動力學指標的影響仍不清楚。在目標體溫管理(TTM)的每個階段對血流動力學的反應也不同。本研究旨在探討心髒驟停複蘇後接受TTM患者的血流動力學參數與臨床結局的關係。

METHODS

The study prospectively enrolled patients who were treated with TTM (33°C for 24h) after cardiac arrest. We assessed clinical and hemodynamic variables at pre-specified time points in survivors and non-survivors as well as among those with favorable vs. poor neurologic outcomes at discharge.

方法：這項前瞻性研究納入了心髒停搏複蘇後接受TTM (33 °C持續24小時)的患者。針對幸存者和非幸存者、以及那些出院時存在有利與不利神經功能預後的患者，我們選擇特定的時間點評估臨床和血流動力學參數。

RESULTS

The study analyzed the records of 95 patients who completed TTM; at discharge 54 (57%) were alive and 21 (22%) had favorable neurological outcomes. Heart rate(HR) at 24h>93/min, cardiac index (CI) at 12h<2.5liter/min/m2and lower average of mean arterial blood pressure(MAP) at 36h and 48h were independently associated with in-hospital mortality (P<0.05 by Cox regression analysis respectively). MAP at 48h between 84 to 110mm Hg and lower HR at 48h were significantly associated with better neurological outcome at discharge (P<0.05 for by logistic regression analysis respectively).

結果：研究分析了95 例完成TTM的患者; 出院時54例(57%)存活，21例(22%)獲得有利的神經係統結局。在24 h時心率> 93次/min，在12h時心髒指數 (CI) <2.5 L/min/m2 以及在36 h 和48 h時平均動脈血液壓(MAP)更低與院內死亡率獨立相關 (P值均< 0.05)。在48 h時MAP84 -110 mmHg、更低的心率與出院時更好地神經功能預後顯著相關 (P 值均< 0.05)。

CONCLUSIONS

Our results indicate that lower MAP and HR more than 93/min are associated with in-hospital mortality during the initial 48hours after ROSC. CI at 12h<2.5liter/min/m2is associated with survival but not with neurological outcome. During the course ofpost-cardiac arrest TTM, these markers of hemodynamic status may be useful predictors of outcomes.

結論：我們的研究結果表明，在ROSC後最初的48小時內，MAP更低、HR大於93次/min與院內死亡率相關。在12h時CI <2.5L/min/m2 與存活率相關，但與神經功能預後不相關。在心髒驟停複蘇後實行TTM過程中，這些表示血流動力學狀態的指標對患者結局的預測可能是有用的。