Patients with End-stage Renal Disease and Hyperkalemic Out-of-hospital Cardiac Arrest Have Improved Survival

末期腎臟病合併高血鉀的到院前心跳停止病人存活率較佳

尤嘉宏(Chia-Hung Yo)；蔡旻珊(Min-Shan Tsai)；馬惠明(Huei-Ming Ma)；方震中(Cheng-Chung Fang)；陳石超(Shyr-Chyr Chen)；蔡光超(Kuang-Chau Tsai)；李建璋(Chien-Chang Lee)

到院前心肺停止 ； 存活率 ； 復甦 ； 高血鉀 ； 併發症 ； out-of-hospital cardiac arrest ； survival ； resuscitation ； hyperkalemia ； comorbidity

Journal of Emergency Medicine, Taiwan

13卷1期（2011 / 03 / 01）

1 - 9

英文

日的：評估到院前心跳停止的病患中是否末期腎臟疾病患者合併高血鉀有較佳的存活率。方法：回溯性世代研究由兩百二十四位成功復甦，並且存活超過24小時的非創傷性到院前心跳停止成人患者。臨床資料的來源是從急診以及加護病房使用標準紀錄格式紀錄，結果指標定義90為天存活率。單變項分析中，類別變項使用卡方檢驗，連續變項使用Mann-Whitney U檢驗；多變項分析使用Cox迴歸模型。結果：在修正了潛在性干擾因素後，我們發現因為嚴重高血押所造成的到院前心跳停止有較佳90的天存活率（危險比，95%信賴區間：0.25，0.14~0.63)。其他重要的不良預後因子包括肝硬化(3.14，1.28~7.67)，較久的CPR時間≧20分鐘(1.81，1.22~2.68)，惡性腫瘤(1.72，1.11~2.66)。而急救成功後在24到48小時中，最佳的格拉斯哥昏迷指數≧5(0.21，0.05~0.86)，因呼吸問題造成的到院前心跳停止(0.55，0.36~0.85)，在恢復自發性循環後平均動脈壓≧100毫米汞柱(0.59，0.40~0.87)，呈現無脈搏電活動節律(0.6，0.1~0.63)，被認為是有利的預後因子。結論：本研究結果表明病患原本的疾病及合併症和造成心跳停止的原因對於存活率有很大的影響。在最初24小時內存活的末期腎臟病患合併高血鉀的到院前心跳停止病人，可能有較佳的存活率。此結論需要進一步的前瞻性研究加以確認。

Objective: To evaluate whether end-stage renal disease (ESRD)-related hyperkalemic arrest is associated with better survival in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA). Methods: The retrospective cohort consisted of 224 adult, non-trauma patients who were successfully resuscitated after OHCA and survived for ＞24 hours. Clinical data from emergency department (ED) and intensive care unit (ICU) medical records were recorded on a standard form. Outcome variables were defined as 90-day survival. Univariate analysis was done using chi-square tests or Mann-Whitney U tests, as indicated. Multivariate analysis was done using Cox-proportional regression model. Results: After adjusting for potential confounders, we found that OHCA caused by ESRD-related hyperkalemia was associated with better 90-day survival (HR=0.25, 95% CI: 0.14-0.63). Other adverse prognostic factors include liver cirrhosis (HR=3.14, 95% CI: 1.28-7.67), CPR duration ≥20 min (HR=1.81, 95% CI: 1.22-2.68), underlying malignancy (HR=1.72, 95% CI: 1.11-2.66). Best Glasgow Coma Scale score 24-48 hours after ROSC ≥5 (HR=0.21, 95% CI: 0.05-0.86), OHCA caused by respiratory events (HR =0.55, 95% CI: 0.36-0.85), mean arterial pressure after ROSC ≥100 mm Hg (HR 0.59, 95% CI: 0.40-0.87), and presenting rhythm of pulseless electric activity (HR=0.6, 95% CI: 0.1-0.63) were found to be favorable prognostic indicators. Conclusions: Our results indicate that the underlying comorbidity and the etiology of arrest have a great influence on survival. Patients with OHCA due to severe hyperkalemia who survive the initial 24 hours may have better survival.