Circulatory trajectories after out-of-hospital cardiac arrest: a prospective cohort study

BMC Anesthesiology

Magnus Løberg¹  Ørjan Gundersen²  Halvor Langeland²  Nils-Kristian Skjærvold²  Daniel Bergum²  Pål Klepstad²  Thomas Skaug³  Knut Bjørnstad³  Trond Nordseth⁴ 

[1] Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo;Department of Anesthesiology and Intensive Care Medicine, St. Olav’s University Hospital;Department of Cardiology, St. Olav’s University Hospital;Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU);

关键词: Out-of-hospital cardiac arrest;    Post-cardiac arrest syndrome;    Circulation;    Hemodynamic;    Cluster;    Sequence analysis;   

DOI  :  10.1186/s12871-021-01434-2

来源: DOAJ

【 摘 要 】

Abstract Background Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of post-cardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU). Methods This was a prospective single-center observational cohort study of patients after OHCA. Circulation was continuously and invasively monitored from the time of admission through the following five days. Every hour, patients were classified into one of three predefined circulatory states, yielding a longitudinal sequence of states for each patient. We used sequence analysis to describe the overall circulatory development and to identify clusters of patients with similar circulatory trajectories. We used ordered logistic regression to identify predictors for cluster membership. Results Among 71 patients admitted to the ICU after OHCA during the study period, 50 were included in the study. The overall circulatory development after OHCA was two-phased. Low cardiac output (CO) and high systemic vascular resistance (SVR) characterized the initial phase, whereas high CO and low SVR characterized the later phase. Most patients were stabilized with respect to circulatory state within 72 h after cardiac arrest. We identified four clusters of circulatory trajectories. Initial shockable cardiac rhythm was associated with a favorable circulatory trajectory, whereas low base excess at admission was associated with an unfavorable circulatory trajectory. Conclusion Circulatory failure after OHCA exhibits time-dependent characteristics. We identified four distinct circulatory trajectories and their characteristics. These findings may guide clinical support for circulatory failure after OHCA. Trial registration ClinicalTrials.gov: NCT02648061

【 授权许可】

Unknown