Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, United States.
Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, United States.
Resuscitation. 2015 Jul;92:122-8. doi: 10.1016/j.resuscitation.2015.05.002. Epub 2015 May 11.
In out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) the frequency-based waveform characteristic, amplitude-spectral area (AMSA) is associated with hospital discharge and good neurological outcome, yet AMSA is also known to increase in response to chest compressions (CC). In addition to rate and depth, well performed CC provides good chest recoil without leaning, reflected in the release velocity (RV). We hypothesized that AMSA is associated with hospital discharge and good neurological outcome independent of CC quality.
OHCA patients (age ≥ 18), with initial rhythm of VF from an Utstein-Style database were analyzed. AMSA was measured prior to each shock, and averaged for each subject (AMSA-avg). Primary endpoint was hospital discharge and secondary endpoint was a good neurological outcome. Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed were age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, first shock AMSA (AMSA1), AMSA-avg, averaged pre-shock pause, CC rate, depth, and RV.
140 subjects were analyzed. Hospital discharge was 31% and with good neurological outcome in 24% (77% of those discharged). AMSA-avg (p < 0.001), RV (p = 0.002), and age (p = 0.029) were independently associated with hospital discharge, with a non-significant trend for witnessed status (p = 0.069), with AUC = 0.846 for the multivariate model. For good neurological outcome, AMSA-avg (p = 0.001) and RV (p = 0.001) remained independently significant, with AUC = 0.782.
In OHCA with an initial rhythm of VF, AMSA-avg and CC RV are both highly and independently associated with hospital discharge and good neurological outcome.
在院外心脏骤停（OHCA）伴心室颤动（VF）中，基于频率的波形特征——幅度谱面积（AMSA）与出院和良好神经功能结局相关，但已知 AMSA 也会随着胸外按压（CC）而增加。除了频率和深度，良好的 CC 还能提供良好的胸廓回弹，而不会倾斜，这反映在释放速度（RV）上。我们假设，AMSA 与 CC 质量无关，与出院和良好神经功能结局独立相关。
对来自 Utstein 式数据库的初始节律为 VF 的 OHCA 患者进行分析。在每次电击前测量 AMSA，并对每个患者进行平均（AMSA-avg）。主要终点是出院，次要终点是良好的神经功能结局。进行单变量和逐步多变量逻辑回归以及接收者操作特征（ROC）分析。分析的因素包括年龄、性别、目击状态、从调度到监测/除颤器应用的时间、电击次数、首次电击 AMSA（AMSA1）、AMSA-avg、平均电击前暂停时间、CC 频率、深度和 RV。
共分析了 140 例患者。出院率为 31%，神经功能良好出院率为 24%（出院患者中有 77%）。AMSA-avg（p<0.001）、RV（p=0.002）和年龄（p=0.029）与出院独立相关，目击状态有非显著趋势（p=0.069），多变量模型的 AUC 为 0.846。对于良好的神经功能结局，AMSA-avg（p=0.001）和 RV（p=0.001）仍然独立显著，AUC 为 0.782。
在初始节律为 VF 的 OHCA 中，AMSA-avg 和 CC RV 均高度独立地与出院和良好的神经功能结局相关。
