初療時の血中アンモニア値で来院時心肺停止例の予後推定は可能か?

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  • Does Blood Ammonia Level at Time of Initial Treatment Predict the Outcome of Patients in Cardiopulmonary Arrest on Arrival?

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Recently, comprehensive medical care is being promoted for when resuscitation is performed on patients in cardiopulmonary arrest on arrival (CPAOA), with an emphasis on not only cardiac resuscitation but also on brain resuscitation. When a patient in CPAOA is transported to hospital, how the arrest occurred and how much time has elapsed from the onset of arrest are frequently unknown. Even in witnessed CPA cases, the time elapsed since CPA is often incorrect, and this information is especially important. In this study, we examined an objective index to enable estimation of the time elapsed from the onset of CPA to the arrival at hospital where emergency management was performed. We studied 225 patients with witnessed intrinsic cardiogenic out-of-hospital CPA (128 male and 97 female) who were transported to our hospital during the period from April 1996 to March 2003. We statistically analyzed the correlation between the blood ammonia level at the time of the initial management and the time elapsed from confirmation of CPA to arrival at the hospital (CPA-arrival time). There was a positive correlation between the blood ammonia level at the time of initial management and the CPA-arrival time. Patients who made a full recovery showed a significantly lower blood ammonia level at the time of initial management than those who did not make a full recovery. Also, many patients whose blood ammonia level was less than 180μg/dl at the time of initial management were able to make a full recovery. Based on these results, we conclude that the blood ammonia level can potentially be used as a useful index for estimating the time elapsed since CPA and the neurological prognosis including brain resuscitation.

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