Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score

RESUSCITATION

卷:126

Article

Pasquier, Mathieu¹  Hugli, Olivier¹  Paal, Peter²  Darocha, Tomasz³  Blancher, Marc⁴  Husby, Paul⁵  Silfvast, Tom^6,7  Carron, Pierre-Nicolas¹  Rousson, Valentin⁸ 

[1] Lausanne Univ Hosp, Emergency Dept, Lausanne, Switzerland

[2] Paracelsus Med Univ, Hosp Bros Hosp, Dept Anesthesiol & Intens Care Med, Strubergasse 21, A-5020 Salzburg, Austria

[3] Med Univ Silesia, Dept Anaesthesiol & Intens Care, Severe Accid Hypothermia Ctr, 055,Poniatowskiego 15, Katowice, Poland

[4] CHU Grenoble, SAMU 38, Pole Urgences Med Aigue, BP 217, F-38043 Grenoble 09, France

[5] Haukeland Hosp, Dept Anesthesia & Intens Care, N-5021 Bergen, Norway

[6] Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, POB 340, Helsinki 00029, Finland

[7] Helsinki Univ Hosp, POB 340, Helsinki 00029, Finland

[8] Lausanne Univ Hosp, Inst Social & Prevent Med, Route Corniche 10, CH-1010 Lausanne, Switzerland

关键词: Cardiac arrest;    ECMO;    ECPR;    Hypothermia;    Accidental;    Potassium;    Resuscitation;    Triage;   

DOI  :  10.1016/j.resuscitation.2018.02.026

来源: Elsevier

【 摘 要 】

Aims: Currently, the decision to initiate extracorporeal life support for patients who suffer cardiac arrest due to accidental hypothermia is essentially based on serum potassium level. Our goal was to build a prediction score in order to determine the probability of survival following rewarming of hypothermic arrested patients based on several covariates available at admission. Methods: We included consecutive hypothermic arrested patients who underwent rewarming with extracorporeal life support. The sample comprised 237 patients identified through the literature from 18 studies, and 49 additional patients obtained from hospital data collection. We considered nine potential predictors of survival: age; sex; core temperature; serum potassium level; mechanism of hypothermia; cardiac rhythm at admission; witnessed cardiac arrest, rewarming method and cardiopulmonary resuscitation duration prior to the initiation of extracorporeal life support. The primary outcome parameter was survival to hospital discharge. Results: Overall, 106 of the 286 included patients survived (37%; 95% CI: 32-43%), most (84%) with a good neurological outcome. The final score included the following variables: age, sex, core temperature at admission, serum potassium level, mechanism of cooling, and cardiopulmonary resuscitation duration. The corresponding area under the receiver operating characteristic curve was 0.895 (95% CI: 0.859-0.931) compared to 0.774 (95% CI: 0.720-0.828) when based on serum potassium level alone. Conclusions: In this large retrospective study we found that our score was superior to dichotomous triage based on serum potassium level in assessing which hypothermic patients in cardiac arrest would benefit from extracorporeal life support. External validation of our findings is required.

【 授权许可】

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