室颤波形的振幅谱面积与院外室颤性心搏骤停患者生存的关系。
Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest.
机构信息
Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona.
Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona.
出版信息
J Am Coll Cardiol. 2014 Sep 30;64(13):1362-9. doi: 10.1016/j.jacc.2014.06.1196.
BACKGROUND
Previous investigations of out-of-hospital cardiac arrest (OHCA) have shown that the waveform characteristic amplitude spectral area (AMSA) can predict successful defibrillation and return of spontaneous circulation (ROSC) but has not been studied previously for survival.
OBJECTIVES
To determine whether AMSA computed from the ventricular fibrillation (VF) waveform is associated with pre-hospital ROSC, hospital admission, and hospital discharge.
METHODS
Adults with witnessed OHCA and an initial rhythm of VF from an Utstein style database were studied. AMSA was measured prior to each shock and averaged for each subject (AMSA-avg). Factors such as age, sex, number of shocks, time from dispatch to monitor/defibrillator application, first shock AMSA, and AMSA-avg that could predict pre-hospital ROSC, hospital admission, and hospital discharge were analyzed by logistic regression.
RESULTS
Eighty-nine subjects (mean age 62 ± 15 years) with a total of 286 shocks were analyzed. AMSA-avg was associated with pre-hospital ROSC (p = 0.003); a threshold of 20.9 mV-Hz had a 95% sensitivity and a 43.4% specificity. Additionally, AMSA-avg was associated with hospital admission (p < 0.001); a threshold of 21 mV-Hz had a 95% sensitivity and a 54% specificity and with hospital discharge (p < 0.001); a threshold of 25.6 mV-Hz had a 95% sensitivity and a 53% specificity. First-shock AMSA was also predictive of pre-hospital ROSC, hospital admission, and discharge. Time from dispatch to monitor/defibrillator application was associated with hospital admission (p = 0.034) but not pre-hospital ROSC or hospital discharge.
CONCLUSIONS
AMSA is highly associated with pre-hospital ROSC, survival to hospital admission, and hospital discharge in witnessed VF OHCA. Future studies are needed to determine whether AMSA computed during resuscitation can identify patients for whom continuing current resuscitation efforts would likely be futile.
背景
先前对院外心脏骤停（OHCA）的研究表明，波形特征幅度谱面积（AMSA）可预测除颤成功和自主循环恢复（ROSC），但之前尚未对其与生存率进行研究。
目的
确定从室颤（VF）波形计算出的 AMSA 是否与院前 ROSC、住院和出院相关。
方法
对来自 utstein 样式数据库的有目击者的 OHCA 和初始 VF 节律的成年人进行了研究。在每次电击前测量 AMSA，并对每个受试者进行平均（AMSA-avg）。通过逻辑回归分析年龄、性别、电击次数、从调度到监测/除颤器应用的时间、首次电击 AMSA 和 AMSA-avg 等因素与院前 ROSC、住院和出院的相关性。
结果
共分析了 89 名受试者（平均年龄 62 ± 15 岁）和总共 286 次电击。AMSA-avg 与院前 ROSC 相关（p = 0.003）；阈值为 20.9 mV-Hz 时，灵敏度为 95%，特异性为 43.4%。此外，AMSA-avg 与住院相关（p < 0.001）；阈值为 21 mV-Hz 时，灵敏度为 95%，特异性为 54%，与出院相关（p < 0.001）；阈值为 25.6 mV-Hz 时，灵敏度为 95%，特异性为 53%。首次电击 AMSA 也可预测院前 ROSC、住院和出院。从调度到监测/除颤器应用的时间与住院相关（p = 0.034），但与院前 ROSC 或出院无关。
结论
在有目击者的 VF OHCA 中，AMSA 与院前 ROSC、存活至住院和出院高度相关。需要进一步的研究来确定在复苏过程中计算出的 AMSA 是否可以识别出继续当前复苏努力可能徒劳无益的患者。
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