Context: Cardiac arrests in adults are often due to ventricular fibrillation(VF) or pulseless ventricular tachycardia(VT), which are associated with better outcomes than asystole or pulseless electrical activity(PEA)....Context: Cardiac arrests in adults are often due to ventricular fibrillation(VF) or pulseless ventricular tachycardia(VT), which are associated with better outcomes than asystole or pulseless electrical activity(PEA). Cardiac arrests in children are typically asystole or PEA. Objective: To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes. Design, Setting, and Patients: A prospective observational study from a multicenter registry(National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36 902 adults(≥ 18 years) and 880 children(<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded. Main Outcome Measure: Survival to hospital discharge. Results: The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults(27% [236/880] vs 18% [6485/36 902]; adjusted odds ratio[OR], 2.29; 95% confidence interval[CI], 1.95- 2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36 902) in adults(OR, 0.54; 95% CI, 0.44- 0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults(OR, 1.20; 95% CI, 1.10- 1.40; P=.006), whereas the prevalence of PEA was 24% (213) in children and 32% (11 963) in adults(OR, 0.67; 95% CI, 0.57- 0.78; P< .001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge(24% [135/563] in children vs 11% [2719/24 987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23- 3.32). Conclusions: In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.展开更多
Objective: We sought to evaluate magnesium as a neuroprotectant in patients un dergoing cardiac surgery with cardiopulmonary bypass. Methods: From February 200 2 to September 2003, 350 patients undergoing elective cor...Objective: We sought to evaluate magnesium as a neuroprotectant in patients un dergoing cardiac surgery with cardiopulmonary bypass. Methods: From February 200 2 to September 2003, 350 patients undergoing elective coronary artery bypass gra fting, valve surgery, or both were enrolled in a randomized, blinded, placebo-c ontrolled trial to receive either magnesium sulfate to increase plasma levels 1( 1/2) to 2 times normal during cardiopulmonary bypass(n=174) or no intervention(n =176). Neurologic function, neuropsychologic function, and depression were asses sed preoperatively,at 24 and 96 hours after extubation(neurologic) and at 3 mont hs(neuropsychologic, depression). Neurologic scores were analyzed using ordinal longitudinal methods, and neuropsychologic and depression inventory data were su mmarized by principal component analysis, followed by linear regression analysis using component scores as response variables. Results: Seven(2%) patients had a postoperative stroke, 2(1%) in the magnesium and 5(3%) in the placebo group( P=.4). Neurologic score was worse postoperatively in both groups(P< .0001); howe ver, magnesium group patients performed better than placebo group patients(P=.00 01), who had prolonged declines in short-term memory and reemergence of primiti ve reflexes. Three-month neuropsychologic performance and depression inventory score were generally better than preoperatively, with few differences between gr oups(P > .6); however, older age(P=.0006), previous stroke(P=.003), and lower ed ucation level(P=.0007) were associated with worse performance. Conclusions: Magn esium administration is safe and improves short-term postoperative neurologic f unction after cardiac surgery, particularly in preserving short-term memory and cortical control over brainstem functions. However, by 3 months, other factors and not administration of magnesium influence neuropsychologic and depression in ventory performance.展开更多
文摘Context: Cardiac arrests in adults are often due to ventricular fibrillation(VF) or pulseless ventricular tachycardia(VT), which are associated with better outcomes than asystole or pulseless electrical activity(PEA). Cardiac arrests in children are typically asystole or PEA. Objective: To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes. Design, Setting, and Patients: A prospective observational study from a multicenter registry(National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36 902 adults(≥ 18 years) and 880 children(<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded. Main Outcome Measure: Survival to hospital discharge. Results: The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults(27% [236/880] vs 18% [6485/36 902]; adjusted odds ratio[OR], 2.29; 95% confidence interval[CI], 1.95- 2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36 902) in adults(OR, 0.54; 95% CI, 0.44- 0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults(OR, 1.20; 95% CI, 1.10- 1.40; P=.006), whereas the prevalence of PEA was 24% (213) in children and 32% (11 963) in adults(OR, 0.67; 95% CI, 0.57- 0.78; P< .001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge(24% [135/563] in children vs 11% [2719/24 987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23- 3.32). Conclusions: In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.
文摘Objective: We sought to evaluate magnesium as a neuroprotectant in patients un dergoing cardiac surgery with cardiopulmonary bypass. Methods: From February 200 2 to September 2003, 350 patients undergoing elective coronary artery bypass gra fting, valve surgery, or both were enrolled in a randomized, blinded, placebo-c ontrolled trial to receive either magnesium sulfate to increase plasma levels 1( 1/2) to 2 times normal during cardiopulmonary bypass(n=174) or no intervention(n =176). Neurologic function, neuropsychologic function, and depression were asses sed preoperatively,at 24 and 96 hours after extubation(neurologic) and at 3 mont hs(neuropsychologic, depression). Neurologic scores were analyzed using ordinal longitudinal methods, and neuropsychologic and depression inventory data were su mmarized by principal component analysis, followed by linear regression analysis using component scores as response variables. Results: Seven(2%) patients had a postoperative stroke, 2(1%) in the magnesium and 5(3%) in the placebo group( P=.4). Neurologic score was worse postoperatively in both groups(P< .0001); howe ver, magnesium group patients performed better than placebo group patients(P=.00 01), who had prolonged declines in short-term memory and reemergence of primiti ve reflexes. Three-month neuropsychologic performance and depression inventory score were generally better than preoperatively, with few differences between gr oups(P > .6); however, older age(P=.0006), previous stroke(P=.003), and lower ed ucation level(P=.0007) were associated with worse performance. Conclusions: Magn esium administration is safe and improves short-term postoperative neurologic f unction after cardiac surgery, particularly in preserving short-term memory and cortical control over brainstem functions. However, by 3 months, other factors and not administration of magnesium influence neuropsychologic and depression in ventory performance.
