Prognostic Factors Associated With Post Cardiac Arrest Syndrome In ICU Admission Patients

BackgroundWith the popularity of cardiopulmonary resuscitation techniques and improve various internal and external causes of hospital cardiopulmonary arrest patients are better and faster treatment, restoration of spontaneous circulation, or to the proportion of the initial successful resuscitation were significantly increased than in the past. CPR based on the National Registry database studies, the hospital cardiopulmonary arrest patients to return to spontaneous circulation rate of 47%, but the final survival rate of only 18% discharged, the hospital mortality rate of up to 63%, ICU discharge rate of only 15.5%, hospital higher death rate. Restoration of spontaneous circulation after cardiopulmonary resuscitation in ICU coma patients during hospitalization was only about 30% survival rate, even if the surviving or remaining in a vegetative state in patients with neurological disorders also account for the majority, only 20% to 30% survived to hospital discharge and retain good neurologic function. Two-thirds of cardiac arrest outside the hospital and the hospital mortality in patients with brain injury related. After cardiopulmonary resuscitation in recent years more limited clinical studies return of spontaneous circulation rates or hospital survival, mortality, after the recovery of organs to determine the prognostic evaluation of the system is not comprehensive.ObjectiveMade on the return of spontaneous circulation after cardiopulmonary resuscitation of patients eventually die neurological recovery prognosis and prognostic factors before and after the recovery of correlation analysis, a comprehensive and systematic understanding of the status and evolution of organ injury. Explore the prognosis of patients eventually die and nervous system factors in the prognosis of recovery. Explore the SOFA score in evaluating the return of spontaneous circulation after cardiopulmonary resuscitation in the prognosis of patients eventually die and the prognosis of the nervous system. Methodsreview from January 2003 to October 2010 occurred in the hospital or hospital cardiopulmonary arrest, the resuscitation, restoration of spontaneous circulation, by the time or the selection at Changzheng Hospital emergency department into the ICU ward for further treatment, or occurred in the hospital ICU cardiopulmonary arrest cases. Case selection criteria: in terms of pre-hospital cardiopulmonary resuscitation: sustained return of spontaneous circulation and transferred to our hospital more than 6h ICU; in terms of hospital cardiopulmonary resuscitation: return of spontaneous circulation, and maintain more than 6h, including in vitro after the application of artificial restoration of spontaneous circulation loop and maintain more than 6h. Excluded under 18 years of age at onset, the data is not complete, rescue abandoned after the onset of early cases and in families with end-stage disease caused by cardiac arrest, hernia formation, cancer and other cases. Finally selected 42 cases; the sample cases selected according to the survival or recovery 28 days after the death group and survival group is divided into; and recovery in patients with neurological outcome 28 days after the CPC score is 2 points less than the nervous system is divided into good prognosis group and poor prognosis group. Then the recovery in patients with neurological outcome 28 days after the CPC score 1 to 3 points, 4 points, 5 points better defined as a neurological outcome group, and the drain group and death group; the reference to the revised cardiac arrest and cardiopulmonary resuscitation evaluation - hospital Utstein model, designed for clinical data in this statistics syndrome after cardiopulmonary resuscitation in patients with the registration form, recovery of the samples collected before and after the relevant factors, biochemical values, SOFA Scores, etc., and accordance with the recovery time span after 2h ~ 24h after the recovery period the value of the measured value is defined as early, 24h ~ 3d period is defined as the measured value of the medium-term values, 3d ~ 1w hours later measured value is defined as the value. application Excel2003 SPSS statistical software, and clinical data for statistical analysis.Results1. he basic situation24h in 42 patients received 38 cases of survival, accounting for 90.5% of all patients with ROSC, survival of the patients had access to 28d in 20 cases, accounting for 47.6% of all patients with ROSC, patients with good prognosis of the nervous system, 6 cases of all patients with ROSC 14.3%.Mean age was 53.12±20.85 years (18-91 years), 26 cases of male patients, average age Methods 49.31±21.03 years; 16 cases of female patients, mean age 59.31±19.63 years; the average age of men and women was no significant difference, p = 0.133.With an average hospital stay was 16.07±14.62 days (1-70 days), male with an average hospital stay was 15.96±12.90 days; women with an average hospital stay was 16.25±17.51 days; the average length of stay between men and women was no significant difference, p = 0.550.2. the recovery of the former factorOnset age, initial rhythm, CPR time, and to resume their own start time and CPR if heart rate occurred in the medical specialized agencies and 28 day survival was correlated (p <0.05 or p <0.01).the recovery factorLactate values within 24h after resuscitation, 48h in low blood pressure status, whether the acid-base balance disturbance, whether coagulation dysfunction, high fever, blood disorders, the occurrence of SIRS; 7d has occurred within the MODS, whether to reinstate 28-day survival with enteral nutrition was associated (p <0.05 or p <0.01).24h lactate values; 48h in hypotension, high fever, whether to resume enteral nutrition and 28 days neurological outcome was correlated (p <0.05 or p <0.01).3. laboratorythe value of early and mid-albumin, lactate dehydrogenase values in late, late total bilirubin, serum creatinine and blood urea nitrogen of the value of the patients survived 28 days was correlated (p <0.05 or p <0.01).The value of lactate dehydrogenase, total bilirubin value of early 28-day neurological function in patients was correlated (p <0.05 or p <0.01).4. Glasgow Coma ScaleGlasgow coma score late and 28 day survival was a positive correlation; all of the Glasgow Coma Scale and 28 days were associated neurological function (p <0.05 or p <0.01).5. SOFA scoreThe recovery rate of hypotension, the rate of oxygenation index, platelet score late, late coma score, total bilirubin late score, the rate of creatinine in urine and the total score on the SOFA with the 28-day survival was correlated (p <0.05 or p <0.01).The state of low blood pressure after resuscitation score, oxygenation index score early and late, late platelet score, the score of the coma, as well as the total SOFA score of neurological function for 28 days was correlated (p <0.05 or p <0.01). 6. the number of organ failureOrgan dysfunction within 3 months, 4 to 5 6 to organ dysfunction and organ dysfunction between 8 and 28 days survival of a significant correlation between (p <0.01).Conclusion1. this group of patients with cardiopulmonary resuscitation 24h survival was 90.5%, 28d survival rate was 47.6%, cardiopulmonary resuscitation was 14.3%.2. the patient's basic condition such as age, cardiac arrest when the initial rhythm and the performance of resuscitation length of time window, whether recovery of the specialized agencies and other factors affecting prognosis of patients died, including younger age, shockable rhythm, a short time Windows, and the specialized agencies, the rescue of a successful recovery is the favorable conditions for recovery.3. the recovery after the body of the various pathological and physiological changes, manifested as the time changes in various organs, biochemical values of lift, coma score, and many other common and easy monitoring of clinical indicators can play the role of good prognosis. Among the early changes of lactic acid, hypotension, acid-base balance, coagulation, blood disorder, fever, nutritional status, liver and kidney function; in the late whether there SIRS, MODS, the eventual resumption of enteral nutrition assessment can play dead Dengjun And prognosis of neurological recovery.4. Glasgow coma scale for prognosis of recovery of neurological function recovery after the evaluation function is clearly stronger than the effect on the prognosis of death.5. SOFA score as an infection-related organ failure assessment score in the evaluation of organ damage after resuscitation status of each can be judged as a simple and easy, and the prognosis of cardiopulmonary resuscitation to play a role.6. the number of organ dysfunction after resuscitation the more worse the prognosis.