Wang An-Yi, Huang Chien-Hua, Chang Wei-Tien, Tsai Min-Shan, Wang Chih-Hung, Chen Wen-Jone
Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Departments of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Emerg Med. 2016 Dec;34(12):2367-2371. doi: 10.1016/j.ajem.2016.08.052. Epub 2016 Aug 27.
Monitoring the partial pressure of end-tidal carbon dioxide (PEtco) has been advocated since 2010 as an index of resuscitation efforts. However, related research has largely focused on out-of-hospital cardiac arrest victims. In-hospital cardiac arrest (IHCA) differs in terms of etiologies and demographics, the merit of initial PEtco values was explored.
This was a retrospective study in a single medical center between February 2011 and August 2014. Eligible subjects had suffered nontraumatic IHCA in the emergency department, where resuscitation was performed in accord with 2010 American Heart Association guidelines. Patients with initial PEtco recordings via capnography were recruited.
A total of 353 IHCA events with initial PEtco were recorded in 202 patients (male, 61.4%; mean age, 67.0 ± 16.2 years). Shockable rhythm (ventricular tachycardia/ventricular fibrillation) accounted for 11.8%. A cut point of 25.5 mm Hg was established for initial PEtco, creating 2 tiers of sustained return of spontaneous circulation (ROSC) that differed significantly in cumulative survival probability (log rank test, P = .002). For patients with initial PEtco <25.5 mm Hg, survival benefit ceased at an earlier point in resuscitation, whereas above this threshold, the probability of survival cumulatively increased for a longer period. In multivariate analysis, initial PEtco >25.5 mm Hg was found independently predictive of sustained ROSC (odds ratio, 2.64; 95% confidence interval, 1.43-4.88; P = .002), and survival to discharge (odds ratio, 3.10; 95% confidence interval, 1.26-7.60; P = .014), but failed to correlate with neurologic outcome.
In IHCA, the therapeutic threshold for initial PEtco should set fairly higher to encourage more pulmonary flow and increase the likelihood of sustained ROSC.
自2010年以来，监测呼气末二氧化碳分压（PEtco）一直被提倡作为复苏效果的一个指标。然而，相关研究主要集中在院外心脏骤停患者。院内心脏骤停（IHCA）在病因和人口统计学方面有所不同，因此探讨了初始PEtco值的价值。
这是一项在2011年2月至2014年8月期间于单一医疗中心进行的回顾性研究。符合条件的受试者在急诊科发生了非创伤性IHCA，并按照2010年美国心脏协会指南进行了复苏。招募了通过二氧化碳图记录初始PEtco的患者。
202例患者（男性占61.4%；平均年龄67.0±16.2岁）共记录到353次伴有初始PEtco的IHCA事件。可电击心律（室性心动过速/心室颤动）占11.8%。确定初始PEtco的切点为25.5 mmHg，形成了2层自主循环恢复（ROSC）持续情况，其累积生存概率有显著差异（对数秩检验，P = 0.002）。对于初始PEtco<25.5 mmHg的患者，复苏早期生存获益就停止了，而高于此阈值，生存概率在更长时间内累积增加。在多变量分析中，发现初始PEtco>25.5 mmHg独立预测ROSC持续（优势比，2.64；95%置信区间，1.43 - 4.88；P = 0.002）以及出院生存（优势比，3.10；95%置信区间，1.26 - 7.60；P = 0.014），但与神经功能结局无关。
在IHCA中，初始PEtco的治疗阈值应设定得相对较高，以促进更多肺血流并增加ROSC持续的可能性。
