Research Unit of Internal Medicine, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Finland.
Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
Resuscitation. 2018 Jan;122:76-78. doi: 10.1016/j.resuscitation.2017.11.064. Epub 2017 Nov 27.
Asystole (ASY) and pulseless electrical activity (PEA) are increasing and ventricular fibrillation (VF) or ventricular tachycardia (VT) declining as presenting rhythms of sudden cardiac arrest (SCA). Since there is limited information on possible differences in the etiology of underlying structural heart disease, we analyzed the clinical and/or autopsy findings of victims with ASY, PEA or VT/VF.
All SCA cases with recorded ASY, PEA or VT/VF occurring after onset of witnessed collapse were analyzed by the emergency personnel between the years 2007-2012 within the Oulu University Hospital area. Underlying structural heart disease was diagnosed by medico-legal autopsy or by clinical investigation (echocardiography, angiography). Of a total number of 659 subjects with a documented rhythm at the time of SCA, 300 were determined to be due to cardiac disease at autopsy or as a result of clinical investigation. Delay was less than 30min from collapse to rhythm recording in 274 subjects (mean age 65±14 yrs; 214 males, 78.1%).
The presenting rhythm was ASY in 87 (31.8%) PEA in 38 (13.9%) and VT/VF in 149 subjects (54.4%). There was no significant difference in the delay from the onset of collapse to the rhythm recording between ASY (11±8min) and VT/VF (9±6min, p=0.06) or PEA (6±8min) and VT/VF (p=0.334). The majority of SCA subjects had an ischemic cause for the event (n=216, 78.8%). Non-ischemic cause for SCA was associated with non-shockable rhythm (Non-ischemic: ASY 46.6% PEA 17.2% VT/VF 36.2% v. Ischemic: ASY 27.8% PEA 13.0% VT/VF 59.3%) even when adjusted for gender, age and delay from collapse to rhythm recording (ASY/PEA v. VT/VF, OR 3.2 95%CI: 1.67-6.50, p=0.001).
Asystole and PEA are a more common presenting rhythm than VT/VF at the time of SCA in non-ischemic cardiac disease. The decreasing trend of ischemic heart disease as a cause of SCA may partly explain the increasing trend of ASY/PEA.
心搏骤停（ASY）和无脉电活动（PEA）的发生率增加，而室颤（VF）或室性心动过速（VT）的发生率下降，成为心搏骤停（SCA）的主要表现节律。由于关于潜在结构性心脏病病因的信息有限，我们分析了具有 ASY、PEA 或 VT/VF 的 SCA 患者的临床和/或尸检结果。
2007-2012 年间，急救人员在奥卢大学医院区域内分析了所有记录到 ASY、PEA 或 VT/VF 的 SCA 病例，这些病例均发生在目击到患者倒下后的发病初期。通过法医解剖或临床调查（超声心动图、血管造影）诊断潜在结构性心脏病。在总共 659 例记录到节律的 SCA 患者中，有 300 例通过尸检或临床调查（超声心动图、血管造影）确定为心脏病。274 例患者从发病到记录节律的时间间隔小于 30 分钟（平均年龄 65±14 岁；214 名男性，占 78.1%）。
87 例（31.8%）的主要表现节律为 ASY，38 例（13.9%）为 PEA，149 例（54.4%）为 VT/VF。从发病到记录节律的时间间隔在 ASY（11±8 分钟）和 VT/VF（9±6 分钟，p=0.06）或 PEA（6±8 分钟）和 VT/VF（p=0.334）之间无显著差异。大多数 SCA 患者的事件原因是缺血（n=216，78.8%）。SCA 的非缺血性病因与非电击性节律相关（非缺血性：ASY 46.6%，PEA 17.2%，VT/VF 36.2%；缺血性：ASY 27.8%，PEA 13.0%，VT/VF 59.3%），即使在调整性别、年龄和从发病到记录节律的时间间隔后也是如此（ASY/PEA 与 VT/VF 相比，OR 3.2；95%CI：1.67-6.50；p=0.001）。
在非缺血性心脏疾病中，与 VT/VF 相比，心搏骤停时 ASY 和 PEA 是更常见的表现节律。缺血性心脏病作为 SCA 病因的减少趋势可能部分解释了 ASY/PEA 的增加趋势。
