Clinical analysis of multiple organ dysfunction syndrome after cardiopulmonary resuscitation / 中华急诊医学杂志

ABSTRACT

Objective To enhance the cognition on the clinical features of post resuscitation multiple organ dysfunction syndrome (PR-MODS) in patients after cardiac arrest, and provide the basis for integrated control. Method Based on the retrospective analysis, the clinical data of 72 patients with cardiac arrest with restoration of spontaneous circulation (ROSC) in ICU were collected, including happening place of cardiac arrest, the type of rhythm first monitored after cardiac arrest, cause of cardiac arrest, incidence of SIRS and MODS, the position and number of organ dysfunction, success rate of CPR, the rate of survival to hospital discharge and cerebral performance categories(CPC) of discharged patients. Results ①In patients with ROSC after cardiac arrest, male to female ratio was 1.181,55 cases was happened in hospital and 17 cases was happened out of hospital, and the ratio was 3.241. ②The distribution of cardiac arrest place ICU,emergency room and operating room were the major places of in-hospital cardiac arrest, adding up to 41 cases and accounting for 74.55% (41/55); the major places of outhospital cardiac arrest were on the way to hospital and in the ambulance, and accounting for 64.71% (11/ 17). ③According to the rhythm first monitored after cardiac arrest, there were 38 cases using shock and 32 cases using non-shock, the ratio was 1.12 1. Cardiac arrest causes of cardiogenic and on-cardiogenic factors are 37 cases and 35 cases, a ratio of 1.061 .④All of the 72 cases, 16 cases died within 24 h, and 56 cases were successfully resuscitated, but 51 cases occurred SIRS after ROSC, 42 cases had combined MODS (42/56,75%), 27 cases(27/42,64.29%)died.The most involving organs in sequence were brain (38 cases, 90.48%), heart (35 cases,83.33%) and lung (28 cases, 66.67%). ⑤Among the 56 successfully resuscitated patients, MODS ( - ) group (14 cases) all survived, 15 cases in MODS ( + ) group (42 cases) survived, a total rate of survived to hospital discharge was 40.28%(29/72). All the MODS ( - ) group ( 14 cases) got CPC 1 point. In MODS ( + ) group, there were 7 cases getting CPC 1-2 point, 35 cases getting CPC 3-5 point. There were no significant difference between sex and age in the two groups (P > 0.05), while the comparison of CPC and survived to hospital discharge rate had statistically significance (P < 0.001). Conclusions The occurrence of SIRS in cardiac arrest patients with ROSC was common and there was high incidence of MODS subsequently. The heart and brain were the mostly involved dysfunctional organs. PR-MODS was an important factor influencing the prognosis of patients with cardiac arrest.