Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia. Results During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ. Conclusions In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.
Abstract
Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia. Results During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ. Conclusions In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.
참고문헌 (33)
- "ECLS international summary of statistics" (2022)[URL]
- Neumar RW, "Part 1 : executive summary. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, 132(18 Suppl 2), pp.S315~67 (2015)
- Ko RE, "The differential neurologic prognosis of low-flow time according to the initial rhythm in patients who undergo extracorporeal cardiopulmonary resuscitation", Resuscitation, 148, pp.121~127 (2020)
- Belohlavek J, "Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest : a randomized clinical trial", JAMA, 327, pp.737~747 (2022)
- Bertic M, "Predictors of survival and favorable neurologic outcome in patients treated with eCPR : a systematic review and meta-analysis", J Cardiovasc Transl Res, 15, pp.279~290 (2022)
- Kliegel A, "Serial lactate determinations for prediction of outcome after cardiac arrest", Medicine(Baltimore), 83, pp.274~279 (2004)
- Garcia-Alvarez M, "Sepsis-associated hyperlactatemia", Crit Care, 18, pp.503~ (2014)
- Bakker J, "Veno-arterial carbon dioxide gradient in human septic shock", Chest, 101, pp.509~515 (1992)
- Mecher CE, "Venous hypercarbia associated with severe sepsis and systemic hypoperfusion", Crit Care Med, 18, pp.585~589 (1990)
- Mesquida J, "Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock", Crit Care, 19, pp.126~ (2015)
- Mallat J, "Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients", Ann Intensive Care, 6, pp.10~ (2016)
- Shinozaki K, "Dissociated oxygen consumption and carbon dioxide production in the post-cardiac arrest rat : a novel metabolic phenotype", J Am Heart Assoc, 7, pp.e007721~ (2018)
- Holzinger U, "Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest : a prospective observational cohort study", Crit Care, 19, pp.128~ (2015)
- Park SB, "Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation", Int J Cardiol, 177, pp.1031~1035 (2014)
- 이지한, "Association between a Multidisciplinary Team Approach and Clinical Outcomes in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation in the Emergency Department", Korean Circulation Journal, 51(11), pp.908~918 (2021), 대한심장학회[DOI]
- Ryu JA, "The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation", Crit Care, 21, pp.15~ (2017)
- Mekontso-Dessap A, "Combination of venoarterial PCO2 difference with arteriovenous O2 content difference to detect anaerobic metabolism in patients", Intensive Care Med, 28, pp.272~277 (2002)
- Cummins RO, "Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council", Circulation, 84, pp.960~975 (1991)
- Geocadin RG, "Standards for studies of neurological prognostication in comatose survivors of cardiac arrest : a scientific statement from the American Heart Association", Circulation, 140, pp.e517~42 (2019)
- Ospina-Tascón GA, "Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock", Intensive Care Med, 41, pp.796~805 (2015)
- Gao X, "Pcv-aCO2", Ca-cvO2 combined with arterial lactate clearance rate as early resuscitation goals in septic shock, 2019, pp.358, 182~190
- Mesquida J, "Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference(PcvaCO2", CavO2)reflects microcirculatory oxygenation alterations in early septic shock, 2019, pp.53, 162~168
- Uber A, "Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest", Resuscitation, 127, pp.89~94 (2018)
- Oshima T, "Fulfilling caloric demands according to indirect calorimetry may be beneficial for post cardiac arrest patients under therapeutic hypothermia", Resuscitation, 88, pp.81~85 (2015)
- Lee DH, "Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest", Resuscitation, 88, pp.143~149 (2015)
- Riveiro DF, "Evaluation of serum lactate, central venous saturation, and venous-arterial carbon dioxide difference in the prediction of mortality in postcardiac arrest syndrome", J Intensive Care Med, 31, pp.544~552 (2016)
- Weil MH, "Acid-base determinants of survival after cardiopulmonary resuscitation", Crit Care Med, 13, pp.888~892 (1985)
- Choi KH, "Risk prediction model of in-hospital mortality in patients with myocardial infarction treated with venoarterial extracorporeal membrane oxygenation", Rev Esp Cardiol(Engl Ed), 72, pp.724~731 (2019)
- Kraut JA, "Lactic acidosis", N Engl J Med, 371, pp.2309~2319 (2014)
- Cipriani E, "Key role of respiratory quotient to reduce the occurrence of hypoxemia during extracorporeal gas exchange : a theoretical analysis", Crit Care Med, 48, pp.e1327~31 (2020)
- Su L, "P(v-a)CO2", C(a-v)O2-directed resuscitation does not improve prognosis compared with SvO2 in severe sepsis and septic shock : a prospective multicenter randomized controlled clinical study, 2018, pp.48, 314~320
- Monnet X, "Lactate and venoarterial carbon dioxide difference", arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders, 2013, pp.41, 1412~1420
- Li X, "Non-invasive measurements of energy expenditure and respiratory quotient by respiratory mass spectrometry in children on extracorporeal membrane oxygenation : a pilot study", Artif Organs, 39, pp.815~819 (2015)