OBJECTIVES: Despite a lack of randomized trials, practice guidelines recommend that mild induced hypothermia be considered for comatose survivors of in-hospital cardiac arrest. This study describes the safety, feasibility, and outcomes of mild induced hypothermia treatment following in-hospital cardiac arrest. DESIGN: Prospective, observational, registry-based study. SETTING: Forty-six critical care facilities in eight countries in Europe and the United States reporting in the Hypothermia Network Registry and the International Cardiac Arrest Registry. PATIENTS: A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A cerebral performance category of 1 or 2 was considered a good outcome. At hospital discharge 41% of patients had a good outcome. At median 6-month follow-up, 34% had a good outcome. Among in-hospital deaths, 52% were of cardiac causes and 44% of cerebral cause. A higher initial body temperature was associated with reduced odds of a good outcome (odds ratio, 0.79; 95% CI, 0.68-0.92). Adverse events were common; bleeding requiring transfusion (odds ratio, 0.56; 95% CI, 0.31-1.00) and sepsis (odds ratio, 0.52; 95% CI, 0.30-0.91) were associated with reduced odds for a good outcome. CONCLUSIONS: In this registry study of an in-hospital cardiac arrest population treated with mild induced hypothermia, we found a 41% good outcome at hospital discharge and 34% at follow-up. Infectious complications occurred in 43% of cases, and 11% of patients required a transfusion for bleeding. The majority of deaths were of cardiac origin.
- MeSH
- časové faktory MeSH
- kóma epidemiologie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- péče o pacienty v kritickém stavu metody MeSH
- prospektivní studie MeSH
- registrace MeSH
- senioři MeSH
- sexuální faktory MeSH
- srdeční arytmie MeSH
- srdeční zástava komplikace terapie MeSH
- tělesná teplota MeSH
- terapeutická hypotermie metody mortalita MeSH
- ukazatele zdravotního stavu MeSH
- věkové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Prognostic stratification of cardiac arrest survivors is essential for the selection of the most appropriate therapeutic strategy. However, accurate early outcome predictions for this patient population remain challenging. At present, there is a lack of data examining the prognostic value of C-terminal provasopressin (copeptin) in cardiac arrest survivors. METHODS: A group of 40 out-of-hospital cardiac arrest survivors who were treated with endovascular hypothermia was analyzed. Copeptin levels were measured in blood samples taken at admission using a commercially available immunoassay. Neurological outcome was assessed at 30 days post admission according to the Cerebral Performance Category (CPC): CPC 1, no neurological deficit; CPC 2, mild to moderate dysfunction; CPC 3, severe dysfunction; CPC 4, coma; and CPC 5, death. RESULTS: Copeptin levels were significantly lower in patients with CPC 1 compared with CPC 2 or CPC 3 to CPC 5 (74.3 +/- 14.4 pmol/l, 219.8 +/- 33.9 pmol/l and 302.7 +/- 52.1 pmol/l, respectively; P < 0.0001). Using an optimal cutoff value <= 217.9 pmol/l calculated from the receiver operating characteristic curve (area under curve = 0.801, 95% confidence interval = 0.644 to 0.910; P = 0.0001), the sensitivity of predicting survival with good neurological outcome was 78.6% and the specificity was 75.0%. Multiple logistic regression analysis revealed that a copeptin level > 217.9 pmol/l was an independent predictor of severe neurological dysfunction or death, with an adjusted odds ratio of 27.00 (95% confidence interval = 2.27 to 321.68; P = 0.009). CONCLUSION: The present study found that copeptin levels have a significant prognostic value at the time of hospital admission, and are a promising diagnostic tool for predicting outcomes in out-of-hospital cardiac arrest survivors.
- MeSH
- biologické markery krev MeSH
- glykopeptidy * krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- přežívající * MeSH
- příjem pacientů * trendy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- terapeutická hypotermie mortalita trendy MeSH
- výsledek terapie MeSH
- zástava srdce mimo nemocnici * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Autoři uvádějí zkušenost s 11 nemocnými, ktery'm bylapro disekci urgentně provedena náhradaascendenxnt aorty a oblouku aorty s využitím techniky hluboké hypotermie se zástavou oběhu. Časnámortalita v souboru čint36,4 %, přičemž 3 ze 4 zemřelých byli již předoperačně v šokovém stavu z nízkého minutového srdečního výdeje. Závažná neurologická komplikace nastala u jednoho, předoperačně hemiparetického nemocného (9,1 %).
The authors present their experiences with 11 patienxs with the aortic dissection, in whom urgent replacement of the ascending aorta and aortic arch was performed with deep hypohermic circulatory arrest. Early mortality was 36.4 % and 3 of 4 patients who died had low cardiac output syndrome before surgery. Severe reeurologic complication was observed in one patienx who was hemiparetic before surgery (9.1 %).
