Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan.

Blood gas assessment Extracorporeal life support Extracorporeal membrane oxygenation (ECMO) Percutaneous cardiopulmonary support (PCPS) Ventricular fibrillation

Journal

Journal of intensive care
ISSN: 2052-0492
Titre abrégé: J Intensive Care
Pays: England
ID NLM: 101627304

Informations de publication

Date de publication:
2020
Historique:
received: 04 02 2020
accepted: 22 04 2020
entrez: 20 5 2020
pubmed: 20 5 2020
medline: 20 5 2020
Statut: epublish

Résumé

We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). We retrospectively analyzed the database of a multicenter prospective observational study on OHCA patients in Osaka prefecture, Japan (CRITICAL study), from July 1, 2012 to December 31, 2016. We included adult OHCA patients treated by ECPR. Patients with OHCA from external causes such as trauma were excluded. We conducted logistic regression analysis to identify the odds ratio (OR) and 95% confidence interval (CI) of the pH value for 1 month favorable neurological outcome adjusted for potential confounders including sex, age, witnessed by bystander, CPR by bystander, pre-hospital initial cardiac rhythm, and cardiac rhythm on hospital arrival. Among the 9822 patients in the database, 260 patients were finally included in the analysis. The three groups were Tertile 1: pH ≥ 7.030, Tertile 2: pH 6.875-7.029, and Tertile 3: pH < 6.875. The adjusted OR of Tertiles 2 and 3 compared with Tertile 1 for 1 month favorable neurological outcome were 0.26 (95% CI 0.10-0.63) and 0.24 (95% CI 0.09-0.61), respectively. This multi-institutional observational study showed that low pH value (< 7.03) before the implementation of ECPR was associated with 1 month unfavorable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR.

Sections du résumé

BACKGROUND BACKGROUND
We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR).
METHODS METHODS
We retrospectively analyzed the database of a multicenter prospective observational study on OHCA patients in Osaka prefecture, Japan (CRITICAL study), from July 1, 2012 to December 31, 2016. We included adult OHCA patients treated by ECPR. Patients with OHCA from external causes such as trauma were excluded. We conducted logistic regression analysis to identify the odds ratio (OR) and 95% confidence interval (CI) of the pH value for 1 month favorable neurological outcome adjusted for potential confounders including sex, age, witnessed by bystander, CPR by bystander, pre-hospital initial cardiac rhythm, and cardiac rhythm on hospital arrival.
RESULTS RESULTS
Among the 9822 patients in the database, 260 patients were finally included in the analysis. The three groups were Tertile 1: pH ≥ 7.030, Tertile 2: pH 6.875-7.029, and Tertile 3: pH < 6.875. The adjusted OR of Tertiles 2 and 3 compared with Tertile 1 for 1 month favorable neurological outcome were 0.26 (95% CI 0.10-0.63) and 0.24 (95% CI 0.09-0.61), respectively.
CONCLUSIONS CONCLUSIONS
This multi-institutional observational study showed that low pH value (< 7.03) before the implementation of ECPR was associated with 1 month unfavorable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR.

Identifiants

DOI: 10.1186/s40560-020-00451-6 PMID: 32426140 PMC: PMC7212572
pubmed: 32426140
doi: 10.1186/s40560-020-00451-6
pii: 451
pmc: PMC7212572
doi:

Types de publication

Journal Article

Langues

eng

Pagination

34

Informations de copyright

© The Author(s) 2020.

Déclaration de conflit d'intérêts

Competing interestsThe authors declare that they have no competing interests.

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Auteurs

Yohei Okada (Y)

1Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
2Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Takeyuki Kiguchi (T)

3Kyoto University Health Service, Yoshida Honmachi, Sakyo, Kyoto, 606-8501 Japan.
Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan.

Taro Irisawa (T)

5Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Kazuhisa Yoshiya (K)

5Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Tomoki Yamada (T)

6Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan.

Koichi Hayakawa (K)

7Department of Emergency and Critical Care Medicine, Takii Hospital, Kansai Medical University, Moriguchi, Japan.

Kazuo Noguchi (K)

8Department of Emergency Medicine, Tane General Hospital, Osaka, Japan.

Tetsuro Nishimura (T)

9Department of Critical Care Medicine, Osaka City University, Osaka, Japan.

Takuya Ishibe (T)

10Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka, Sayama Japan.

Yoshiki Yagi (Y)

11Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan.

Masafumi Kishimoto (M)

Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-, Osaka, Japan.

Hiroshi Shintani (H)

Senshu Trauma and Critical Care Center, Osaka, Japan.

Yasuyuki Hayashi (Y)

Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan.

Taku Sogabe (T)

15Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.

Takaya Morooka (T)

16Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan.

Haruko Sakamoto (H)

17Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan.

Keitaro Suzuki (K)

18Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan.

Fumiko Nakamura (F)

19Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka Japan.

Norihiro Nishioka (N)

1Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.

Tasuku Matsuyama (T)

20Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Junya Sado (J)

21Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

Satoshi Matsui (S)

21Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

Takeshi Shimazu (T)

5Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Kaoru Koike (K)

2Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Takashi Kawamura (T)

1Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
3Kyoto University Health Service, Yoshida Honmachi, Sakyo, Kyoto, 606-8501 Japan.

Tetsuhisa Kitamura (T)

21Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

Taku Iwami (T)

1Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
3Kyoto University Health Service, Yoshida Honmachi, Sakyo, Kyoto, 606-8501 Japan.

Classifications MeSH