Background

While inhaled nitric oxide (iNO) has revealed benefit in cardiac arrest in an animal model, no published data has yet demonstrated the impact of iNO in humans with cardiac arrest.

Methods

In this pilot study, we administered iNO, along with standard post-resuscitative care, in adults with in-hospital cardiac arrest (IHCA) following achievement of return of spontaneous circulation (ROSC) at an academic tertiary medical center. Patients receiving iNO were compared to age-matched controls with IHCA receiving standard care from an institutional registry. The primary outcome was survival to discharge; secondary outcome was favorable neurologic outcome, defined by a Glasgow Outcome Score of 4 or 5. Propensity-score (PS) matching analysis was performed between patients receiving iNO versus controls.

Results

Twenty adults with IHCA receiving iNO were compared to 199 controls with IHCA. Similar age, Charlson comorbidity index, and initial rhythm were noted in both groups. Patients receiving iNO had higher rates of survival to discharge compared to controls (35% vs 11%, p < 0.0001) but no difference in favorable neurologic outcome (15% vs 9%, p = 0.39) in the unmatched population. In the PS-matched analysis, patients receiving iNO had higher survival to discharge (35% vs 20%, p = 0.0344) than the control group but no difference in favorable neurologic outcome (15% vs 20%, p = 0.13) were noted between both groups.

Conclusions

In this pilot study, iNO was associated with significantly higher rates of survival to discharge but not favorable neurologic outcome among patients with IHCA compared to controls. This benefit was also observed in the PS-matched analysis. A large scale randomized controlled trial comparing standard of care supplemented with iNO to standard of care alone is warranted in patients with cardiac arrest (Funded by Stony Brook University Renaissance School of Medicine, ClinicalTrials.gov number, NCT04134078).

中文翻译：

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院内心脏骤停成人吸入一氧化氮：可行性研究

背景

虽然吸入一氧化氮 (iNO) 在动物模型中揭示了心脏骤停的益处，但尚未发表的数据证明 iNO 对心脏骤停的人类的影响。

方法

在这项试点研究中，我们在一家学术性三级医疗中心实现自主循环 (ROSC) 恢复后，对院内心脏骤停 (IHCA) 的成人进行了 iNO 以及标准的复苏后护理。将接受 iNO 的患者与接受来自机构登记处的标准护理的 IHCA 的年龄匹配对照进行比较。主要结果是生存出院；次要结果是良好的神经系统结果，由 4 或 5 的格拉斯哥结果评分定义。在接受 iNO 的患者与对照组之间进行倾向评分 (PS) 匹配分析。

结果

将 20 名接受 iNO 的 IHCA 成人与 199 名接受 IHCA 的对照进行了比较。两组的年龄、Charlson 合并症指数和初始节律相似。与对照组相比，接受 iNO 的患者出院生存率更高（35% vs 11%，p < 0.0001），但在无与伦比的人群中，良好的神经系统结果没有差异（15% vs 9%，p = 0.39）。在 PS 匹配分析中，接受 iNO 的患者的出院生存率（35% 对 20%，p = 0.0344）高于对照组，但在良好的神经系统结果方面没有差异（15% 对 20%，p = 0.13）。两组之间。

结论

在这项初步研究中，与对照组相比，iNO 与 IHCA 患者的出院生存率显着提高相关，但神经系统预后不佳。在 PS 匹配分析中也观察到了这种益处。有必要在心脏骤停患者中进行一项大规模随机对照试验，比较补充 iNO 的护理标准与单独的护理标准（由石溪大学文艺复兴医学院资助，ClinicalTrials.gov 编号，NCT04134078）。