RESUMEN
Background: The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results: All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions: In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.
RESUMEN
In Stone's milestone article on damage-control surgery (DCS) (Ann Surg 1983; 197:532-535), detailed clinical observations of abdominal compartment syndrome (ACS) were presented although the concept of ACS had not yet been established at that time. Since then the concept of ACS has been developed concomitantly with the widespread application of DCS for severe trauma victims. Intraabdominal pressure (IAP) is the most important factor for determining the severity of pathophysiological consequences in patients with ACS. Increased IAP pushes the diaphragm upward, which may cause deterioration of pulmonary function. Increased IAP decreases the glomerular filtration rate and urinary secretion. Patients with severe torso injury may have intraabdominal and/or retroperitoneal hematomaor edema formation in the mesentery, and all those can be factors that elevate IAP. About one-third of patients who undergo DCS develop ACS. Decompression of IAP clearly ameliorates physiological parameters in those patients, although the, mortality rate may not be improve despite adequate control of IAP. This suggest that in addition to elevated IAP other factors such as increased cytokine production might be important in ACS. Inserting a plastic infusion bag between intraabdominal organs and the abdominal wall rather than suturing a plastic bag to the edge of the opened abdominal wall may be preferable for further reconstruction of the wall.