Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, Rochester, MN, USA; Knowledge and Evaluation Research Unit, Rochester, MN, USA.
Resuscitation. 2015 Mar;88:138-42. doi: 10.1016/j.resuscitation.2014.10.010. Epub 2014 Oct 23.
Following defibrillation, ventricular fibrillation (VF) frequently recurs during out-of-hospital cardiac arrest (OHCA). Prior studies have reported conflicting results regarding its association with survival. The aim of this study was to examine the impact of recurrent VF in the presence of first responders before advanced life support (ALS) interventions.
Electrocardiographic data from first responder automated external defibrillators (AEDs) were analyzed. A successful shock was defined as termination of VF for 5s or longer. Recurrent VF was defined as any VF that occurred after a successful shock. The primary outcome was neurologically intact survival to hospital discharge (CPC 1-2).
108 patients within our emergency system experienced a witnessed VF arrest. Of these, 73 (68%) had at least one recurrence of VF. Median time to recurrence of VF was 25s [interquartile range (IQR) 11-66s]. Median time in recurrent VF was 180s (IQR 105-266s). Survival was observed in 25 (71%) of patients with no recurrent VF and in 36 (49%) who had recurrence. Recurrent VF was associated with a lower odds of survival on univariate analysis (OR 0.39, 95% CI 0.16-0.92, p=0.0325). After adjusting for bystander CPR, gender and age, recurrent VF had a similar direction of effect but was no longer significantly associated with neurologically intact survival (OR 0.44, 95% CI 0.17-1.11, p=0.081).
In the presence of first responders, VF recurred in 68% of patients. Recurrent VF was associated with a lower odds of survival, though its prognostic significance appeared to be blunted when considered in light of confounding variables. Recurrent VF may have significant survival implications, and further studies to assess its prognostic significance should be performed.
在院外心脏骤停（OHCA）期间，除颤后心室颤动（VF）经常复发。先前的研究报告了其与存活率之间存在相互矛盾的结果。本研究旨在检查在高级生命支持（ALS）干预之前，有第一反应者存在时复发性 VF 的影响。
分析第一反应者自动体外除颤器（AED）的心电图数据。成功电击定义为 VF 终止 5s 或更长时间。复发性 VF 定义为成功电击后发生的任何 VF。主要结局是到出院时神经功能完整的存活（CPC 1-2）。
我们的急救系统中有 108 名患者经历了目击 VF 骤停。其中，73 名（68%）至少有一次 VF 复发。VF 复发的中位时间为 25s[四分位间距（IQR）11-66s]。复发性 VF 的中位时间为 180s（IQR 105-266s）。无复发性 VF 的患者中有 25 例（71%）存活，而复发性 VF 的患者中有 36 例（49%）存活。VF 复发与单变量分析中存活率降低相关（OR 0.39，95%CI 0.16-0.92，p=0.0325）。在校正旁观者 CPR、性别和年龄后，复发性 VF 具有相似的效果方向，但与神经功能完整的存活不再显著相关（OR 0.44，95%CI 0.17-1.11，p=0.081）。
在有第一反应者的情况下，68%的患者 VF 复发。复发性 VF 与存活率降低相关，但考虑到混杂因素，其预后意义似乎减弱。复发性 VF 可能对生存有重大影响，应进一步研究评估其预后意义。
