[持续监测呼气末二氧化碳分压对院内复苏结局的预测价值：一项多中心观察性研究数据的二次分析]
[Predictive value of continuous monitoring end-tidal carbon dioxide partial pressure on in-hospital resuscitation outcome: secondary analysis of the data from a multicenter observational study].
作者信息
Sun Feng, Li Chen, Fu Yangyang, Tan Dingyu, Shao Shihuan, Xu Jun, Zhu Huadong, Yu Xuezhong
机构信息
Department of Emergency, Peking Union Medical College Hospital of Chinese Academy of Medical Sciences, Beijing 100730, China (Sun F, Fu YY, Xu J, Zhu HD, Yu XZ); Department of Emergency, Tianjin Medical University General Hospital, Tianjin 300052, China (Li C); Department of Emergency, Jiangsu Provincial Subei People's Hospital, Yangzhou 225001, Jiangsu, China (Tan DY); Department of Emergency, Peking University People's Hospital, Beijing 100044, China (Shao SH). Corresponding author: Yu Xuezhong, Email:
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jan;30(1):29-33. doi: 10.3760/cma.j.issn.2095-4352.2018.01.006.
OBJECTIVE
To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure (PCO) on the outcome of in-hospital cardiopulmonary resuscitation (CPR), and explored the indicators of termination of resuscitation.
METHODS
A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PCO were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PCO in restoration of spontaneous circulation (ROSC) and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PCO ≤ 10 mmHg (1 mmHg = 0.133 kPa) for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic (ROC) curve was plotted, and the predictive value of PCO ≤ 10 mmHg for different duration on the outcome of CPR was evaluated.
RESULTS
A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PCO value, PCO value failed to explained the clinical conditions, or patients had not monitored PCO within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PCO in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg: 17 (11, 27) vs. 9 (6, 16), P < 0.01]. ROC curve analysis showed that the area under ROC curve (AUC) of PCO during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval (95%CI) = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value (PPV) was 84.6%, and negative predictive value (NPV) was 46.9%. The duration of PCO ≤ 10 mmHg was used for further analysis, which showed that with PCO ≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%.
CONCLUSIONS
For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PCO ≤10 mmHg may be an indicate of termination of CPR.
目的
探讨持续监测呼气末二氧化碳分压（PCO₂）对院内心肺复苏（CPR）结局的预测价值，并探索复苏终止指标。
方法
对一项多中心观察性研究数据进行二次分析。筛选对象为成年非创伤性院内CPR患者，且在CPR开始后30分钟内记录了PCO₂。回顾临床资料。记录自主循环恢复（ROSC）和未恢复自主循环（non-ROSC）患者的平均PCO₂。通过持续评估CPR 1、3、5、8、10分钟时PCO₂≤10 mmHg（1 mmHg = 0.133 kPa）的情况来评估CPR结局。绘制受试者工作特征（ROC）曲线，评估不同持续时间的PCO₂≤10 mmHg对CPR结局的预测价值。
结果
共筛选出467例复苏患者，其中419例完全康复。排除院外复苏、非成年人、创伤性损伤、无PCO₂值、PCO₂值无法解释临床情况或在复苏开始后30分钟内未监测PCO₂的患者，最终纳入120例成年非创伤性院内复苏患者进行分析。50例ROSC患者的平均PCO₂显著高于70例non-ROSC患者[mmHg：17（11，27） vs. 9（6，16），P < 0.01]。ROC曲线分析显示，复苏期间PCO₂预测恢复结局的ROC曲线下面积（AUC）为0.712[95%置信区间（95%CI） = 0.689 - 0.735]；当截断值为10.5 mmHg时，灵敏度为57.8%，特异度为78.0%，阳性预测值（PPV）为84.6%，阴性预测值（NPV）为46.9%。以PCO₂≤10 mmHg的持续时间进行进一步分析，结果显示，随着PCO₂≤10 mmHg持续时间的延长，预测患者未恢复的灵敏度从58.2%降至28.2%，但特异度从39.4%增至100%；PPV从40%增至100%，NPV从57.5%降至34.2%。
结论
对于成年非创伤性院内CPR患者，持续10分钟PCO₂≤10 mmHg可能提示CPR终止。
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