Division of Emergency Medicine, Department of Medicine, UC San Diego, San Diego, CA, United States.
Resuscitation. 2013 Jan;84(1):25-30. doi: 10.1016/j.resuscitation.2012.07.040. Epub 2012 Sep 14.
Compression pauses may be particularly harmful following the electrical recovery but prior to the mechanical recovery from cardiopulmonary arrest.
A convenience sample of patients with out-of-hospital cardiac arrest (OOHCA) were identified. Data were exported from defibrillators to define compression pauses, electrocardiogram rhythm, PetCO2, and the presence of palpable pulses. Pulse-check episodes were randomly assigned to a derivation set (one-third) and a validation set (two-thirds). Both an unweighted and a weighted receiver-operator curve (ROC) analysis were performed on the derivation set to identify optimal thresholds to predict ROSC using heart rate and PetCO2. A sequential decision guideline was generated to predict the presence of ROSC during compressions and confirm perfusion once compressions were stopped. The ability of this decision guideline to correctly identify pauses in which pulses were and were not palpated was then evaluated. A total of 145 patients with 349 compression pauses were included. The ROC analyses on the derivation set identified an optimal pre-pause heart rate threshold of >40 beats min(-1) and an optimal PetCO2 threshold of >20 mmHg to predict ROSC. A sequential decision guideline was developed using pre-pause heart rate and PetCO2 as well as the PetCO2 pattern during compression pauses to predict and rapidly confirm ROSC. This decision guideline demonstrated excellent predictive ability to identifying compression pauses with and without palpable pulses (positive predictive value 95%, negative predictive value 99%). The mean latency period between recovery of electrical and mechanical cardiac function was 78 s (95% CI 36-120 s).
Heart rate and PetCO2 can predict ROSC without stopping compressions, and the PetCO2 pattern during compression pauses can rapidly confirm ROSC. Use of a sequential decision guideline using heart rate and PetCO2 may reduce unnecessary compression pauses during critical moments during recovery from cardiopulmonary arrest.
在心肺复苏后电复律恢复但机械复律恢复之前，按压暂停可能特别有害。
本研究便利选取了院外心脏骤停（OHCA）患者。从除颤器中导出数据以定义按压暂停、心电图节律、PetCO2 和可触及脉搏的存在。脉搏检查事件被随机分配到推导集（三分之一）和验证集（三分之二）。在推导集中对未加权和加权接收者操作特征（ROC）曲线分析进行了分析，以使用心率和 PetCO2 识别预测 ROSC 的最佳阈值。生成了一个序贯决策指南，以预测在按压期间是否存在 ROSC，并在停止按压后确认灌注。然后评估该决策指南正确识别脉搏可触及和不可触及的暂停的能力。共纳入了 145 例患者的 349 次按压暂停。推导集的 ROC 分析确定了预测 ROSC 的最佳预暂停心率阈值>40 次/min 和最佳 PetCO2 阈值>20mmHg。使用预暂停心率和 PetCO2 以及按压期间的 PetCO2 模式制定了序贯决策指南，以预测并快速确认 ROSC。该决策指南在识别有可触及和不可触及脉搏的按压暂停方面具有出色的预测能力（阳性预测值 95%，阴性预测值 99%）。电和机械心脏功能恢复之间的平均潜伏期为 78s（95%CI 36-120s）。
心率和 PetCO2 可以在不停止按压的情况下预测 ROSC，按压期间的 PetCO2 模式可以快速确认 ROSC。使用心率和 PetCO2 的序贯决策指南可能会减少心肺复苏恢复过程中关键时刻的不必要按压暂停。
