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Tytuł:
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Cardiac output, heart rate and stroke volume during targeted temperature management after out-of-hospital cardiac arrest: Association with mortality and cause of death.
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Autorzy:
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Grand J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: .
Kjaergaard J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Bro-Jeppesen J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Wanscher M; Department of Cardiothoracic Anaesthesia 4142, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
Nielsen N; Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Lindholm MG; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Thomsen JH; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Boesgaard S; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Hassager C; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Źródło:
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Resuscitation [Resuscitation] 2019 Sep; Vol. 142, pp. 136-143. Date of Electronic Publication: 2019 Jul 27.
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Typ publikacji:
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Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Limerick : Elsevier/north-Holland Biomedical Press
Original Publication: London, Middlesex Pub. Co.
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MeSH Terms:
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Cardiac Output*
Heart Rate*
Hemodynamics*
Hypothermia, Induced*/adverse effects
Hypothermia, Induced*/methods
Out-of-Hospital Cardiac Arrest*/blood
Out-of-Hospital Cardiac Arrest*/mortality
Out-of-Hospital Cardiac Arrest*/physiopathology
Out-of-Hospital Cardiac Arrest*/therapy
Stroke Volume*
Aged ; Arterial Pressure ; Brain Death ; Cardiopulmonary Resuscitation/adverse effects ; Cardiopulmonary Resuscitation/methods ; Cause of Death ; Female ; Humans ; Lactic Acid/analysis ; Male ; Mortality ; Outcome and Process Assessment, Health Care
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Contributed Indexing:
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Keywords: Cardiac arrest; Cardiac index; Hemodynamic parameters; Mortality; Post-cardiac arrest syndrome; Targeted temperature management
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Substance Nomenclature:
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33X04XA5AT (Lactic Acid)
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Entry Date(s):
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Date Created: 20190731 Date Completed: 20200917 Latest Revision: 20200917
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Update Code:
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20240105
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DOI:
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10.1016/j.resuscitation.2019.07.024
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PMID:
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31362081
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Aim: Myocardial dysfunction and low cardiac index are common after out-of-hospital cardiac arrest (OHCA) as part of the post-cardiac arrest syndrome. This study investigates the association of cardiac index during targeted temperature management (TTM) with mortality.
Methods: In the TTM-trial, which randomly allocated patients to TTM of 33 °C or 36 °C for 24 h, we prospectively and consecutively monitored 151 patients with protocolized measurements from pulmonary artery catheters (PAC) as a single site substudy. Cardiac index, heart rate and stroke volume were measured at 3 time-points during the 24 h TTM period and averaged. Uni- and multivariate Cox regression was used to assess association with mortality.
Results: Of 151 patients, 50 (33%) were deceased after 180 days. Cardiac index during TTM was not significantly associated with mortality in univariate (HR: 0.84 [0.54-1.31], p = 0.59) or multivariate analyses (HR adjusted : 1.03 [0.57-1.83], p = 0.93). Cardiac index during TTM was also not significantly associated with non-neurological death (HR adjusted : 1.25 [0.43-3.59], p = 0.68). Higher heart rate (p = 0.03) and lower stroke volume (p = 0.04) were associated with increased mortality in univariate, but not multivariate analyses. No hemodynamic variables were associated with cerebral death, however, increasing lactate during TTM (HR adjusted : 2.15 [1.19-3.85], p = 0.01) and lower mean arterial pressure during TTM (HR adjusted : 0.89 [0.81-0.97], p = 0.008) were independently associated with non-neurological death.
Conclusion: Cardiac index during TTM after resuscitation from OHCA is not associated with mortality. Future studies should investigate whether certain subgroups of patients could benefit from targeting higher goals for cardiac index.
(Copyright © 2019 Elsevier B.V. All rights reserved.)