A Survey On The Implementation Of The Early Goal-directed Therapy For The Patients Suffered With Post Cardiac Arrest Syndrome In Suzhou Area

Objective: To investigate the implementation of the early goal-directed therapy forthe patients suffered with post cardiac arrest syndrome in Suzhou area, in order to evaluatethe quality of early goal-directed therapy, analysis of the relationship between thecompliance rates of the early goal-directed therapy and neurological outcome.Methods: This was a retrospective cohort study; we carried out the investigation withdata for individual patients recorded in the Utstein style, collecting the following indicators:mean arterial pressure (MAP), Peripheral oxygen saturation (SpO2), partial pressure ofcarbon dioxide (PaCO2), blood glucose (Glu) and body temperature (T) during first48h inthe patients achive ROSC after out-of-hospital or in-hospital cardiac arrest and admittedinto ICUs of ten general hospitals in Suzhou area from January2009to December2010.According to the CPC score at ICU discharge, patients were divided into good neurologicaloutcome group (CPC1to2) and poor neurological outcome group (CPC3to5), comparethe compliance rate of these indicators between two groups. Statistically significantvariables included in the Logistic multivariate regression analysis, to understand the impactof the compliance rate of these indicators to neurological outcome.Results: A total of101CA patients were included for analysis,17patients in goodneurological outcome group (good group),84patients in poor neurological outcomegroup(poor group). In the overall compliance rate of the indicators of the goal-directedtherapy, SpO2and MAP reached a higher compliance rate,90.1%and81.4%respectively;Glu and PaCO2reached a lower compliance rate,55.4%and32.8%respectively; MTH reached the lowest compliance rate, only5%. The per capita monitoring frequency ofPaCO2, Glu, and T and the compliance rate of MAP, SpO2, PaCO2and Glu had significantdifferences between ten hospitals, P＜0.05. There was a statistical significance in thecompliance rate of SpO2and MAP between good neurological outcome group and poorgroup (96.6％vs88.6％,85.2％vs80.5％, P＜0.01). The ratio of bystander CPR ingood group was significantly higher than the poor group (88%vs59%, P＜0.05); the timecardiac arrest to return of spontaneous circulation (CA-ROSC) in good group wassignificantly shorter than the poor group (16.5min vs26.5min, P＜0.05). Logisticmultivariate regression analysis showed that the time CA-ROSC was an independent riskfactor of the patient’s neurological outcomes (95%confidence interval0.902to0.996, P <0.05).Conclusion: Currently, there is still room to further improve in the early goal-directedtherapy for the patients suffered with post cardiac arrest syndrome in Suzhou area,especially in the management of body temperature and carbon dioxide. Early return ofspontaneous circulation may improve neurological outcome in patients suffered fromcardiac arrest, the early goal-directed therapy after ROSC is also an important part ofimproving the prognosis of post cardiac arrest syndrome.