- 作者：Florian H. Seeger ; MD ; Florian.Seeger@kgu.de ; Moritz Toenne ; BSc ; Ralf Lehmann ; MD ; Joachim R. Ehrlich ; MD ; FESC ; FHRS ; FAHA
- 关键词：CPR ; pH ; Prognosis ; Lactate ; NSE
- 刊名：Journal of Critical Care
- 出版年：2013
- 出版时间：June, 2013
- 年：2013
- 卷：28
- 期：3
- 页码：317.e13-317.e20
- 全文大小：495 K
Purpose
The purpose was to determine the prognostic value of broadly available clinical parameters such as pH and lactate for early stratification of outcome after cardiopulmonary resuscitation.Methods
We analyzed patients with status postresuscitation who were admitted to the Frankfurt University hospital. Arterial pH and serum lactate levels were dichotomized as ¡°high¡± or ¡°low.¡± Primary end point was a combination of death or severe hypoxic brain damage within 30 days.
Results
In total, 67 % of 206 patients (66 ¡À 12 years) reached the primary end point. Univariate analysis showed that age more than 65 years (hazard ratio [HR] 1.7; 95 % confidence interval (CI), 1.2-2.4), high lactate (> 6.94 mmol/L [62.5 mg/dL)]; HR 2.8; 95 % CI 2.0-3.9), and low pH (< 7.21; HR 2.7; 95 % CI 1.9-3.8) on admission were associated with the end point. Upon multivariate analysis, age more than 65 years, high lactate, and low pH on admission remained as independent predictors. Specificity and sensitivity to detect patients with an end point were 0.51 and 1.0 for the combination of low pH, high lactate, and age more than 65 years (negative predictive value, 1.0).
Conclusion
A combination of clinical data and broadly available parameters can help to stratify prognosis of patients after cardiopulmonary resuscitation with sufficiently high predictive value. Interestingly, a combination of the 3 parameters¡ªage more than 65 years, high lactate, and low pH upon admission¡ªhad a sensitivity of 1.0 for a poor outcome after return of spontaneous circulation.