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      Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea

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      https://www.riss.kr/link?id=A108739653

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      다국어 초록 (Multilingual Abstract)

      Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known.
      Methods Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia.
      Results During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ.
      Conclusions In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.
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      Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods Medical records o...

      Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known.
      Methods Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia.
      Results During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ.
      Conclusions In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

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      참고문헌 (Reference)

      1 Mecher CE, "Venous hypercarbia associated with severe sepsis and systemic hypoperfusion" 18 : 585-589, 1990

      2 Bakker J, "Veno-arterial carbon dioxide gradient in human septic shock" 101 : 509-515, 1992

      3 Ko RE, "The differential neurologic prognosis of low-flow time according to the initial rhythm in patients who undergo extracorporeal cardiopulmonary resuscitation" 148 : 121-127, 2020

      4 Ryu JA, "The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation" 21 : 15-, 2017

      5 Geocadin RG, "Standards for studies of neurological prognostication in comatose survivors of cardiac arrest : a scientific statement from the American Heart Association" 140 : e517-42, 2019

      6 Kliegel A, "Serial lactate determinations for prediction of outcome after cardiac arrest" 83 : 274-279, 2004

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      8 Choi KH, "Risk prediction model of in-hospital mortality in patients with myocardial infarction treated with venoarterial extracorporeal membrane oxygenation" 72 : 724-731, 2019

      9 Holzinger U, "Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest : a prospective observational cohort study" 19 : 128-, 2015

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      1 Mecher CE, "Venous hypercarbia associated with severe sepsis and systemic hypoperfusion" 18 : 585-589, 1990

      2 Bakker J, "Veno-arterial carbon dioxide gradient in human septic shock" 101 : 509-515, 1992

      3 Ko RE, "The differential neurologic prognosis of low-flow time according to the initial rhythm in patients who undergo extracorporeal cardiopulmonary resuscitation" 148 : 121-127, 2020

      4 Ryu JA, "The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation" 21 : 15-, 2017

      5 Geocadin RG, "Standards for studies of neurological prognostication in comatose survivors of cardiac arrest : a scientific statement from the American Heart Association" 140 : e517-42, 2019

      6 Kliegel A, "Serial lactate determinations for prediction of outcome after cardiac arrest" 83 : 274-279, 2004

      7 Garcia-Alvarez M, "Sepsis-associated hyperlactatemia" 18 : 503-, 2014

      8 Choi KH, "Risk prediction model of in-hospital mortality in patients with myocardial infarction treated with venoarterial extracorporeal membrane oxygenation" 72 : 724-731, 2019

      9 Holzinger U, "Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest : a prospective observational cohort study" 19 : 128-, 2015

      10 Cummins RO, "Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council" 84 : 960-975, 1991

      11 Mallat J, "Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients" 6 : 10-, 2016

      12 Uber A, "Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest" 127 : 89-94, 2018

      13 Bertic M, "Predictors of survival and favorable neurologic outcome in patients treated with eCPR : a systematic review and meta-analysis" 15 : 279-290, 2022

      14 Gao X, "Pcv-aCO2/Ca-cvO2 combined with arterial lactate clearance rate as early resuscitation goals in septic shock" 358 : 182-190, 2019

      15 Neumar RW, "Part 1 : executive summary. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 132 (132): S315-67, 2015

      16 Su L, "P(v-a)CO2/C(a-v)O2-directed resuscitation does not improve prognosis compared with SvO2 in severe sepsis and septic shock : a prospective multicenter randomized controlled clinical study" 48 : 314-320, 2018

      17 Li X, "Non-invasive measurements of energy expenditure and respiratory quotient by respiratory mass spectrometry in children on extracorporeal membrane oxygenation : a pilot study" 39 : 815-819, 2015

      18 Kraut JA, "Lactic acidosis" 371 : 2309-2319, 2014

      19 Monnet X, "Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders" 41 : 1412-1420, 2013

      20 Cipriani E, "Key role of respiratory quotient to reduce the occurrence of hypoxemia during extracorporeal gas exchange : a theoretical analysis" 48 : e1327-31, 2020

      21 Oshima T, "Fulfilling caloric demands according to indirect calorimetry may be beneficial for post cardiac arrest patients under therapeutic hypothermia" 88 : 81-85, 2015

      22 Riveiro DF, "Evaluation of serum lactate, central venous saturation, and venous-arterial carbon dioxide difference in the prediction of mortality in postcardiac arrest syndrome" 31 : 544-552, 2016

      23 Belohlavek J, "Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest : a randomized clinical trial" 327 : 737-747, 2022

      24 Extracorporeal Life Support Organization (ELSO), "ECLS international summary of statistics" ELSO

      25 Shinozaki K, "Dissociated oxygen consumption and carbon dioxide production in the post-cardiac arrest rat : a novel metabolic phenotype" 7 : e007721-, 2018

      26 Park SB, "Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation" 177 : 1031-1035, 2014

      27 Lee DH, "Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest" 88 : 143-149, 2015

      28 Mekontso-Dessap A, "Combination of venoarterial PCO2 difference with arteriovenous O2 content difference to detect anaerobic metabolism in patients" 28 : 272-277, 2002

      29 Ospina-Tascón GA, "Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock" 41 : 796-805, 2015

      30 Mesquida J, "Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference(PcvaCO2/CavO2)reflects microcirculatory oxygenation alterations in early septic shock" 53 : 162-168, 2019

      31 Mesquida J, "Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock" 19 : 126-, 2015

      32 이지한 ; Ryoung Eun Ko ; Taek Kyu Park ; Yang Hyun Cho ; Gee Young Suh ; Jeong Hoon Yang, "Association between a Multidisciplinary Team Approach and Clinical Outcomes in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation in the Emergency Department" 대한심장학회 51 (51): 908-918, 2021

      33 Weil MH, "Acid-base determinants of survival after cardiopulmonary resuscitation" 13 : 888-892, 1985

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