Cut-off values of serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest: A retrospective multi-centre study

RESUSCITATION

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Article

Brugger, Hermann^1,2,3  Bouzat, Pierre⁴  Pasquier, Mathieu^3,5  Mair, Peter⁶  Fieler, Julia^3,7,8  Darocha, Tomasz⁹  Blancher, Marc^3,10,11  de Riedmatten, Matthieu¹²  Falk, Markus¹  Paal, Peter^3,13  Strapazzon, Giacomo^1,3  Zafren, Ken^3,14  Maeder, Monika Brodmann^1,15 

[1] EURAC Res, Inst Mt Emergency Med, Drususallee 1, I-39100 Bolzano, Italy

[2] Med Univ Innsbruck, Innsbruck, Austria

[3] Int Commiss Mt Emergency Med ICAR MEDCOM, Kloten, Switzerland

[4] Univ Hosp Grenoble Alpes, Grenoble Alps Trauma Ctr, Dept Anaesthesiol & Crit Care, F-38043 Grenoble 09, France

[5] CHU Vaudois, Lausanne Univ Hosp Ctr, Emergency Serv, BH 09, CH-1011 Lausanne, Switzerland

[6] Med Univ Innsbruck, Dept Anaesthesiol & Crit Care Med, Anichstr 35, A-6020 Innsbruck, Austria

[7] Univ Hosp North Norway, Div Surg Med & Intens Care, Tromso, Norway

[8] Artic Univ Norway, Anaesthesia & Crit Care Res Grp, N-9037 Tromso, Norway

[9] Med Univ Silesia, Dept Anaesthesiol & Intens Care, Medykow 14, PL-40752 Katowice, Poland

[10] Univ Hosp Grenoble Alpes, Dept Emergency Med, Grenoble, France

[11] French Mt Rescue Assoc ANMSM, F-38043 Grenoble 09, France

[12] Sion Hosp, Dept Emergency Med, Sion, Switzerland

[13] Paracelsus Med Univ, Hospitallers Bros Hosp, Dept Anaesthesiol & Intens Care, Kajetanerpl 1, A-5020 Salzburg, Austria

[14] Stanford Univ, Sch Med, Dept Emergency Med, Stanford, CA USA

[15] Univ Bern, Bern Univ Hosp, Inselspital, Dept Emergency Med, Freiburgstr 16C, CH-3010 Bern, Switzerland

关键词: Avalanche;    Out-of-hospital cardiac arrest;    Extracorporeal life support;    Hypothermia;    Serum potassium;   

DOI  :  10.1016/j.resuscitation.2019.04.025

来源: Elsevier

【 摘 要 】

Aim: Evidence of existing guidelines for the on-site triage of avalanche victims is limited and adherence suboptimal. This study attempted to find reliable cut-off values for the identification of hypothermic avalanche victims with reversible out-of-hospital cardiac arrest (OHCA) at hospital admission. This may enable hospitals to allocate extracorporeal life support (ECLS) resources more appropriately while increasing the proportion of survivors among rewarmed victims. Methods: All avalanche victims with OHCA admitted to seven centres in Europe capable of ECLS from 1995 to 2016 were included. Optimal cut-off values, for parameters identified by logistic regression, were determined by means of bootstrapping and exact binomial distribution and served to calculate sensitivity, rate of overtriage, positive and negative predictive values, and receiver operating curves. Results: In total, 103 avalanche victims with OHCA were included. Of the 103 patients 61 (58%) were rewarmed by ECLS. Six (10%) of the rewarmed patients survived whilst 55 (90%) died. We obtained optimal cut-off values of 7 mmol/L for serum potassium and 30 degrees C for core temperature. Conclusion: For in-hospital triage of avalanche victims admitted with OHCA, serum potassium accurately predicts survival. The combination of the cutoffs 7 mmol/L for serum potassium and 30 degrees C for core temperature achieved the lowest overtriage rate (47%) and the highest positive predictive value (19%), with a sensitivity of 100% for survivors. The presence of vital signs at extrication is strongly associated with survival. For further optimisation of in-hospital triage, larger datasets are needed to include additional parameters.

【 授权许可】

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