Olasveengen Theresa M, Samdal Martin, Steen Petter Andreas, Wik Lars, Sunde Kjetil
Institute for Experimental Medical Research, Ulleval University Hospital, N-0407 Oslo, Norway.
Resuscitation. 2009 Jan;80(1):24-9. doi: 10.1016/j.resuscitation.2008.09.003. Epub 2008 Dec 10.
Cardiac arrest patients with initial non-shockable rhythm progressing to shockable rhythm have been reported to have inferior outcome to those remaining non-shockable. We wanted to confirm this observation in our prospectively collected database, and assess whether differences in cardiopulmonary resuscitation (CPR) quality could help to explain any such difference in outcome.
All out-of-hospital cardiac arrest (OHCA) cases in the Oslo EMS between May 2003 and April 2008 were retrospectively studied, and cases with initial asystole or pulseless electrical activity (PEA) were selected. Pre-hospital and hospital records, Utstein forms, and continuous ECGs were reviewed. Quality of CPR and outcome were compared for patients who progressed to a shockable rhythm and patients who remained in non-shockable rhythms.
Of 753 cases with initial non-shockable rhythms 517 (69%) had asystole and 236 (31%) PEA. Ninety-eight (13%) patients progressed to a shockable rhythm, while 653 (87%) remained non-shockable during the entire resuscitation effort (two unknown). Hands-off ratio was higher in the shockable than the non-shockable group, 0.21+/-0.12 vs. 0.16+/-0.10 (p=0.000) with no significant difference in compression and ventilation rates. Overall survival to hospital discharge was 3%; 7% in the shockable and 2% in the non-shockable group (p=0.014). Based on a multivariate logistic analysis young age, initial PEA, and progressing to a shockable rhythm were associated with better outcome.
Progressing from initial non-shockable rhythms to a shockable rhythm was associated with improved outcome after OHCA. This occurred despite more pauses in chest compressions in the shockable group, probably related to defibrillation attempts.
据报道，初始心律不可电击转复但进展为可电击转复心律的心脏骤停患者，其预后较那些始终保持不可电击转复心律的患者更差。我们希望在我们前瞻性收集的数据库中证实这一观察结果，并评估心肺复苏（CPR）质量的差异是否有助于解释这种预后差异。
对2003年5月至2008年4月奥斯陆紧急医疗服务中心所有院外心脏骤停（OHCA）病例进行回顾性研究，选取初始为心搏骤停或无脉电活动（PEA）的病例。查阅院前和医院记录、Utstein表格及连续心电图。比较进展为可电击转复心律的患者和始终保持不可电击转复心律的患者的CPR质量及预后。
在753例初始心律不可电击转复的病例中，517例（69%）为心搏骤停，236例（31%）为PEA。98例（13%）患者进展为可电击转复心律，而653例（87%）在整个复苏过程中始终保持不可电击转复心律（2例情况不明）。可电击转复组的手离胸比例高于不可电击转复组，分别为0.21±0.12和0.16±0.10（p = 0.000），按压和通气频率无显著差异。总体出院存活率为3%；可电击转复组为7%，不可电击转复组为2%（p = 0.014）。基于多因素逻辑分析，年轻、初始为PEA以及进展为可电击转复心律与较好的预后相关。
院外心脏骤停后，从初始不可电击转复心律进展为可电击转复心律与预后改善相关。尽管可电击转复组胸外按压有更多中断，可能与除颤尝试有关，但仍出现了这种情况。
