Hulleman Michiel, Mes Hanne, Blom Marieke T, Koster Rudolph W
Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Resuscitation. 2016 Sep;106:113-9. doi: 10.1016/j.resuscitation.2016.06.033. Epub 2016 Jul 12.
Bradyasystolic heart rhythms are often recorded in out-of-hospital cardiac arrest (OHCA). Atrioventricular (AV) conduction disorders might lead to OHCA, but the prevalence of AV-conduction disorders and other bradyasystolic rhythms in OHCA is unknown. These patients might benefit from pre-hospital pacing. We aimed to determine the prevalence of different types of bradyasystolic heart rhythms in OHCA, including third degree AV-block, and document survival rates.
We used data from the ARREST-registry of OHCA in the Netherlands. Patients with bradyasystolic OHCA in 2006-2012 were included. ECGs were classified according to the presence of P-waves and QRS complexes in five rhythm groups. Differences in survival to discharge in relation to resuscitation characteristics, rhythm and pacing were tested using Chi-Square test and multivariate regression analysis.
We included 2333 patients with a bradyasystolic rhythm; 371 patients (16%) presented with a third degree AV-block. In total 45 patients (1.9%, 95%-CI 1.4-2.5%) survived. A third degree AV-block (adjusted OR 0.86, 95%-CI 0.38-1.96) or pacing (adjusted OR 0.89, 95%-CI 0.21-3.78) was not associated with survival. Pacing was initiated in 110 patients (4.7%), after a long delay (median 18.7min). The strongest association with survival was found for the presence of a bradycardia (vs. asystole) (adjusted OR 4.20, 95%-CI 1.79-9.83), bystander witnessed (OR 4.13, 95%-CI 1.45-11.8) and EMS witnessed collapse (OR 5.18, 95%-CI 2.77-9.67).
In bradyasystolic OHCA, 16% of all patients present with third degree AV-block, but survival for these and other bradyasystolic patients remains poor. Pacing is seldom initiated, often delayed, and rarely beneficial.
心脏停搏的缓慢心律常记录于院外心脏骤停（OHCA）。房室（AV）传导障碍可能导致OHCA，但OHCA中AV传导障碍和其他心脏停搏缓慢心律的患病率尚不清楚。这些患者可能从院前起搏中获益。我们旨在确定OHCA中不同类型心脏停搏缓慢心律的患病率，包括三度房室传导阻滞，并记录生存率。
我们使用了荷兰OHCA的ARREST注册研究数据。纳入2006 - 2012年发生心脏停搏缓慢心律的OHCA患者。根据P波和QRS波群的存在将心电图分为五个心律组。使用卡方检验和多因素回归分析来测试与复苏特征、心律和起搏相关的出院生存率差异。
我们纳入了2333例心脏停搏缓慢心律患者；371例（16%）表现为三度房室传导阻滞。共有45例患者（1.9%，95%可信区间1.4 - 2.5%）存活。三度房室传导阻滞（校正比值比0.86，95%可信区间0.38 - 1.96）或起搏（校正比值比0.89，95%可信区间0.21 - 3.78）与生存率无关。110例患者（4.7%）开始起搏，延迟时间较长（中位数18.7分钟）。发现与生存最密切相关的因素是存在心动过缓（与心脏停搏相比）（校正比值比4.20，95%可信区间1.79 - 9.83）、旁观者目击（比值比4.13，95%可信区间1.45 - 11.8）和急救医疗服务人员目击心脏骤停（比值比5.18，95%可信区间2.77 - 9.67）。
在心脏停搏缓慢心律的OHCA中，所有患者中有16%表现为三度房室传导阻滞，但这些患者和其他心脏停搏缓慢心律患者的生存率仍然很低。起搏很少启动，经常延迟，且很少有益。
