Prediction of outcome after resuscitation from out-of-hospital ventricular fibrillation treated with therapeutic hypothermia
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摘要
Two periods were compared, an historical one (36 patients) between 2000 and 2002 where therapeutic hypothermia was never used, and a recent period (32 patients) between 2003 and 2005 where therapeutic hypothermia (32–34 °C) was implemented prospectively in our unit. Cooling was obtained by simply using wet cloths and ice packs. Survival in the two groups and factors associated with survival were analysed, together with the neurological prognosis in discharged patients.

Results

Survival was significantly higher in the hypothermia group (56%versus 36%), whereas no significant difference was observed in severity between the two periods. Only age, time from return to spontaneous circulation <20 min, and therapeutic hypothermia were independently associated with survival. Therapeutic hypothermia was well tolerated and was associated with a significant improvement in neurological outcome. Whereas only 23%of patients actually reached the target temperature in 2003, 100%did in 2005.

Conclusion

Therapeutic hypothermia is efficient in significantly improving survival and neurological outcome of out-of-hospital cardiac arrest with ventricular fibrillation. By using a simple method, it can be implemented easily and quickly, without side effects.


m/science?_ob=MImg&_imagekey=B6T19-4NWW6S0-2-C&_cdi=4885&_user=10&_orig=article&_coverDate=11%2F30%2F2007&_sk=999249997&view=c&wchp=dGLbVlb-zSkzk&md5=68a6d1b3f4f59528c65f14a641a162cb&ie=/sdarticle.pdf">mg name="pdf" style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (194 K)
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mg src="/scidirimg/bullet_square.gif" alt="">mt=high&_coverDate=05%2F31%2F2006&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f8e4a28e54fd3816b1a5995fa8fb69ac" onMouseOver="InfoBubble.show('infobubble_2','mlktLink_2')" onMouseOut="InfoBubble.timeout()">Comparison of 30 and the 100%inspired oxygen concentra...
Resuscitation
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mg border=0 src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> m/science?_ob=ArticleURL&_udi=B6T19-4JBGJBN-1&_user=10&_coverDate=05%2F31%2F2006&_rdoc=1&_fmt=high&_orig=article&_cdi=4885&_sort=v&_docanchor=&view=c&_ct=621&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e8ea3ace08e4670032a5da0420406400">Comparison of 30 and the 100%inspired oxygen concentrations during early post-resuscitation period: a randomised controlled pilot study
Resuscitation, Volume 69, Issue 2, May 2006, Pages 199-206
M. Kuisma, J. Boyd, V. Voipio, A. Alaspää, R.O. Roine, P. Rosenberg

Abstract
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Summary

Objectives

High oxygen concentration in blood may be harmful in the reperfusion phase after cardiopulmonary resuscitation. We compared the effect of 30 and 100%inspired oxygen concentrations on blood oxygenation and the level of serum markers (NSE, S-100) of neuronal injury during the early post-resuscitation period in humans.

Methods

Patients resuscitated from witnessed out-of-hospital ventricular fibrillation were randomised after the return of spontaneous circulation (ROSC) to be ventilated either with 30%(group A) or 100%(group B) oxygen for 60 min. Main outcome measures were NSE and S-100 levels at 24 and 48 h after ROSC, the adequacy of oxygenation at 10 and 60 min after ROSC and, in group A, the need to raise FiO2 to avoid hypoxaemia. Blood oxygen saturation <95%was the threshold for this intervention.

Results

Thirty-two patients were randomised and 28 (14 in group A and 14 in group B) remained eligible for the final analysis. The mean PaO2 at 10 min was 21.1 kPa in group A and 49.7 kPa in group B. The corresponding values at 60 min were 14.6 and 46.5 kPa. PaO2 values did not fall to the hypoxaemic level in group A. In another group FiO2 had to be raised in five cases (36%) but in two cases it was returned to 0.30 rapidly. The mean NSE at 24 and 48 h was 10.9 and 14.2 μg/l in group A and 13.0 and 18.6 μg/l in group B (ns). S-100 at corresponding time points was 0.21 and 0.23 μg/l in group A and 0.73 and 0.49 μg/l in group B (ns). In the subgroup not treated with therapeutic hypothermia in hospital NSE at 24 h was higher in group B (mean 7.6 versus 13.5 μg/l, p = 0.0487).

Conclusions

Most patients had acceptable arterial oxygenation when ventilated with 30%oxygen during the immediate post-resuscitation period. There was no indication that 30%oxygen with SpO2 monitoring and oxygen backup to avoid SpO2 < 95%did worse that the group receiving 100%oxygen. The use of 100%oxygen was associated with increased level of NSE at 24 h in patients not treated with therapeutic hypothermia. The clinical significance of this finding is unknown and an outcome-powered study is feasible.


m/science?_ob=MImg&_imagekey=B6T19-4JBGJBN-1-2&_cdi=4885&_user=10&_orig=article&_coverDate=05%2F31%2F2006&_sk=999309997&view=c&wchp=dGLbVlb-zSkzk&md5=c7d90afe939331d8209384655f7f2b7e&ie=/sdarticle.pdf">mg name="pdf" style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (108 K)
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mg src="/scidirimg/bullet_square.gif" alt="">mt=high&_coverDate=04%2F30%2F2005&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0fcc2c3be534139621c9fe715883aa34" onMouseOver="InfoBubble.show('infobubble_3','mlktLink_3')" onMouseOut="InfoBubble.timeout()">Outcome after cardiac arrest: predictive values and lim...
Resuscitation
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mg border=0 src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> m/science?_ob=ArticleURL&_udi=B6T19-4F7B481-9&_user=10&_coverDate=04%2F30%2F2005&_rdoc=1&_fmt=high&_orig=article&_cdi=4885&_sort=v&_docanchor=&view=c&_ct=621&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2de65af3e335aab7b4150ee2e9f39524">Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale
Resuscitation, Volume 65, Issue 1, April 2005, Pages 49-55
Rüdiger Pfeifer, Angelika Börner, Andreas Krack, Holger H. Sigusch, Ralf Surber, Hans R. Figulla

Abstract
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Background and purpose:

Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002.

Results:

52.6%of the patients died, 28.8%survived with severe, moderate or without neurological disorders, and 18.6%remained in a persistent vegetative state. Unconsciousness >48 h after CPR predicted a 60.6-fold (95%CI 14.3287–257.205, p = 0.001) and a Glasgow Coma Scale (GCS) <6 points after 72 h a 11.2-fold (CI 95%, 3.55–36.44, p < 0.001) risk of poor neurological outcome. Serum levels ≥ 65 ng/ml for NSE and ≥ 1.5 μg/l for S-100 increased the risk of death and persistent vegetative state 16.8 (95%CI 2.146–131.520)- and 12.6 (95%CI 1.1093–99.210)-fold, respectively. By combination of the GCS with elevated serum concentrations of both neuroproteins above the cut off levels on third day after CPR a poor neurological outcome was predicted with a specificity of 100%.

Conclusion:

The combination of GCS with the serum levels of both neuroproteins at 72 h after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents.


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