Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24119 Kiel, Germany.
Resuscitation. 2011 Dec;82(12):1553-7. doi: 10.1016/j.resuscitation.2011.06.034. Epub 2011 Jul 6.
Haemodynamic optimisation is a fundamental goal of post-cardiac arrest therapy. Therefore, predicting volume responsiveness is a key issue in therapy of these high-risk patients and transoesophageal echocardiography (TEE) may provide helpful information. The aim of the present study was to evaluate the performance of visual evaluation (eyeballing) of standardised TEE-loops to predict volume responsiveness during post-cardiac arrest period.
After approval of the local animal investigation committee, TEE mid-oesophageal long-axis views were recorded before a 5 ml/kg volume bolus at baseline and both 1 and 4h after return of spontaneous circulation (ROSC) from 8 min electrically induced cardiac arrest. Post-hoc, TEE loops were independently presented in randomized order to 7 blinded TEE-experts and 14 blinded TEE novices who were asked to predict whether the ventricle will increase stroke volume ≥ 15% after volume loading or not. Statistics were performed calculating sensitivity and specificity for the correct evaluation and agreement of raters.
14 out of 20 pigs were successfully resuscitated, and 924 ratings from 21 echocardiographers were included into analysis. Overall, we observed a sensitivity between 71 and 100%, whereas the specificity showed rather low values between 0 and 67% for prediction of volume responsiveness. Best prediction was recorded 1h after ROSC with median sensitivity (95% CI) of 100% (89-100%) and median specificity of 67% (61-72%). No significant difference was found between ratings of experienced and inexperienced echocardiographers. The concordance rate within the two groups was comparable.
In post-cardiac arrest period, visual evaluation of long-axis TEE loops allows prediction of volume responsiveness with good sensitivity and reasonable specificity even by novice users, and may therefore be suitable for implementation into treatment protocols.
血流动力学优化是心脏骤停后治疗的基本目标。因此，预测容量反应性是这些高危患者治疗的关键问题，经食管超声心动图（TEE）可能提供有帮助的信息。本研究的目的是评估标准化 TEE 环的视觉评估（目测）预测心脏骤停后期间容量反应性的性能。
在获得当地动物研究委员会的批准后，在基线时、自主循环恢复（ROSC）后 1 小时和 4 小时记录 TEE 食管中段长轴视图，从电诱导的心脏骤停 8 分钟后。事后，将 TEE 环以随机顺序呈现给 7 名盲法 TEE 专家和 14 名盲法 TEE 新手，要求他们预测在容量负荷后心室是否会增加 15%以上的搏出量。统计学计算了正确评估和评分者一致性的敏感性和特异性。
20 头猪中有 14 头成功复苏，21 名超声心动图专家共进行了 924 次评分，纳入分析。总体而言，我们观察到预测容量反应性的敏感性在 71%至 100%之间，而特异性在 ROSC 后 1 小时的敏感性（95%CI）为 100%（89-100%）和特异性为 67%（61-72%）之间显示出较低的值。有经验和无经验的超声心动图专家的评分之间没有发现显著差异。两组内的一致性率相当。
在心脏骤停后期间，长轴 TEE 环的视觉评估可预测容量反应性，具有良好的敏感性和合理的特异性，即使是新手用户也可以使用，因此可能适合纳入治疗方案。
