American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators.
Crit Care Med. 2010 Jan;38(1):101-8. doi: 10.1097/CCM.0b013e3181b43282.
To determine the relationship of electrocardiographic rhythm during cardiac arrest with survival outcomes.
Prospective, observational study.
Total of 411 hospitals in the National Registry of Cardiopulmonary Resuscitation.
Total of 51,919 adult patients with pulseless cardiac arrests from April 1999 to July 2005.
Registry data collected included first documented rhythm, patient demographics, pre-event data, event data, and survival and neurologic outcome data. Of 51,919 indexed cardiac arrests, first documented pulseless rhythm was ventricular tachycardia (VT) in 3810 (7%), ventricular fibrillation (VF) in 8718 (17%), pulseless electrical activity (PEA) in 19,262 (37%) and asystole 20,129 (39%). Subsequent VT/VF (that is, VT or VF occurring during resuscitation for PEA or asystole) occurred in 5154 (27%), with first documented rhythm of PEA and 4988 (25%) with asystole. Survival to hospital discharge rate was not different between those with first documented VF and VT (37% each, adjusted odds ratio [OR]) 1.08; 95% confidence interval [CI] 0.95-1.23). Survival to hospital discharge was slightly more likely after PEA than asystole (12% vs. 11%, adjusted OR 1.1; 95% CI 1.00-1.18), Survival to discharge was substantially more likely after first documented VT/VF than PEA/asystole (adjusted OR 1.68; 95% CI 1.55-1.82). Survival to discharge was also more likely after PEA/asystole without subsequent VT/VF compared with PEA/asystole with subsequent VT/VF (14% vs. 7% for PEA without vs. with subsequent VT/VF; 12% vs. 8% for asystole without vs. with subsequent VT/VF; adjusted OR 1.60; 95% CI, 1.44-1.80).
Survival to hospital discharge was substantially more likely when the first documented rhythm was shockable rather than nonshockable, and slightly more likely after PEA than asystole. Survival to hospital discharge was less likely following PEA/asystole with subsequent VT/VF compared to PEA/asystole without subsequent VT/VF.
确定心脏骤停时心电图节律与生存结果的关系。
前瞻性观察研究。
心肺复苏国家注册中心的 411 家医院。
1999 年 4 月至 2005 年 7 月期间，51919 名无脉性心脏骤停的成年患者。
注册数据包括首次记录的节律、患者人口统计学资料、事件前数据、事件数据以及生存和神经功能结局数据。在索引性心脏骤停的 51919 例中，首次记录的无脉性节律为室性心动过速（VT）3810 例（7%）、心室颤动（VF）8718 例（17%）、无脉性电活动（PEA）19262 例（37%）和心搏停止 20129 例（39%）。随后发生 VT/VF（即 PEA 或心搏停止期间发生的 VT 或 VF）的有 5154 例（27%），首次记录的节律为 PEA，4988 例（25%）为心搏停止。存活至出院的比率在首次记录的 VF 和 VT 之间没有差异（分别为 37%，调整后的优势比[OR]1.08；95%置信区间[CI]0.95-1.23）。PEA 后存活至出院的可能性略高于心搏停止（12%比 11%，调整后的 OR 1.1；95%CI 1.00-1.18）。与 PEA/心搏停止后无后续 VT/VF 相比，首次记录的 VT/VF 后存活至出院的可能性明显更高（调整后的 OR 1.68；95%CI 1.55-1.82）。与 PEA/心搏停止后有后续 VT/VF 相比，PEA/心搏停止后无后续 VT/VF 存活至出院的可能性也更高（PEA 无后续 VT/VF 为 14%，有后续 VT/VF 为 7%；无后续 VT/VF 为 12%，有后续 VT/VF 为 8%；调整后的 OR 1.60；95%CI，1.44-1.80）。
首次记录的节律为可电击性而非非可电击性时，存活至出院的可能性明显更高，PEA 后存活至出院的可能性略高于心搏停止。与 PEA/心搏停止后无后续 VT/VF 相比，PEA/心搏停止后有后续 VT/VF 存活至出院的可能性更低。
