Department of Emergency Medicine and Prehospital Services, St.Olav Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA.
Resuscitation. 2019 Feb;135:45-50. doi: 10.1016/j.resuscitation.2019.01.006. Epub 2019 Jan 9.
During paediatric cardiopulmonary resuscitation (CPR), patients may transition between pulseless electrical activity (PEA), asystole, ventricular fibrillation/tachycardia (VF/VT), and return of spontaneous circulation (ROSC). The aim of this study was to quantify the dynamic characteristics of this process.
ECG recordings were collected in patients who received CPR at the Children's Hospital of Philadelphia (CHOP) between 2006 and 2013. Transitions between PEA (including bradycardia with poor perfusion), VF/VT, asystole, and ROSC were quantified by applying a multi-state statistical model with competing risks, and by smoothing the Nelson-Aalen estimator of cumulative hazard.
Seventy-four episodes of cardiac arrest were included. Median age of patients was 15 years [IQR 11-17], 50% were female and 62% had a respiratory aetiology of arrest. Presenting cardiac arrest rhythms were PEA (60%), VF/VT (24%) and asystole (16%). A temporary surge of PEA was observed between 10 and 15 min due to a doubling of the transition rate from ROSC to PEA (i.e. 're-arrests'). The prevalence of sustained ROSC reached an asymptotic value of 30% at 20 min. Simulation suggests that doubling the transition rate from PEA to ROSC and halving the relapse rate might increase the prevalence of sustained ROSC to 50%.
Children and adolescents who received CPR were prone to re-arrest between 10 and 15 min after start of CPR efforts. If the rate of PEA to ROSC transition could be increased and the rate of re-arrests reduced, the overall survival rate may improve.
在儿科心肺复苏（CPR）过程中，患者可能会经历无脉性电活动（PEA）、心搏停止、心室颤动/心动过速（VF/VT）和自主循环恢复（ROSC）之间的转变。本研究旨在量化这一过程的动态特征。
2006 年至 2013 年间，在费城儿童医院（CHOP）接受 CPR 的患者中收集心电图记录。通过应用具有竞争风险的多状态统计模型和对累积风险的 Nelson-Aalen 估计值进行平滑处理，来量化 PEA（包括灌注不良的心动过缓）、VF/VT、心搏停止和 ROSC 之间的转变。
共纳入 74 例心脏骤停事件。患者的中位年龄为 15 岁[IQR 11-17]，50%为女性，62%的心脏骤停病因与呼吸系统有关。初始心脏骤停节律为 PEA（60%）、VF/VT（24%）和心搏停止（16%）。由于 ROSC 向 PEA 的转变率增加了一倍（即“再停搏”），在 10 至 15 分钟之间观察到 PEA 的暂时激增。模拟结果表明，将 PEA 向 ROSC 的转变率提高一倍，并将复发率降低一半，可能会将持续 ROSC 的发生率提高到 50%。
接受 CPR 的儿童和青少年在 CPR 开始后 10 至 15 分钟内容易再次停搏。如果能够增加 PEA 向 ROSC 的转变率并降低再次停搏的发生率，则整体存活率可能会提高。
