Department of Anesthesia and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy.
Department of Anesthesia and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy.
Resuscitation. 2019 May;138:8-14. doi: 10.1016/j.resuscitation.2019.02.027. Epub 2019 Feb 27.
Survival after cardiac arrest depends on adequate cardiopulmonary resuscitation (CPR). Manual or mechanical external chest compression may be ineffective to restore circulation: structures subjected to external chest compression may differ in forces transfer to intrathoracic structures due to anatomic characteristics and physiological changes. This clinical study aims to assess the association of trans-oesophageal findings during CPR and successful resuscitation.
Retrospective cohort study. Trans-oesophageal assessment of right ventricular fractional area change, right ventricular outflow tract fractional shortening, left ventricular volumes, ejection fraction, and aortic diameters were performed in refractory out-of-hospital cardiac arrest patients admitted to emergency department for extracorporeal CPR.
19 patients were analyzed. 15 of 19 patients (79%) received venous-arterial extracorporeal membrane oxygenation support. Resuscitation was successful with return of spontaneous circulation or electromechanical activity in 7 patients (group-SUXX) and failed in 12 patients (group-FAIL). 6 patients (32%) were alive at 24 h from the cardiac arrest, one patient (5%) survived to hospital discharge. Left ventricular outflow tract (LVOT) was open during CPR in all patients in group-SUXX and in 1 patient in group-FAIL (p 0.0002). None of the patients with closed LVOT had successful resuscitation. Patients in group-SUXX had a higher ejection fraction (p 0.03), ascending aortic diameter (p 0.04), and survival rate than those in group-FAIL (p 0.015). In a multiple variable Cox's proportional model LVOT opening was the only variable associated with successful resuscitation.
Trans-oesophageal echocardiography can be useful in the emergency setting of cardiopulmonary arrest for discriminating between successful and failing resuscitation.
心脏骤停后的存活率取决于充分的心肺复苏（CPR）。手动或机械外部胸部按压可能无法有效恢复循环：由于解剖结构和生理变化，外部胸部按压作用的结构可能会导致向胸腔内结构传递的力不同。这项临床研究旨在评估心肺复苏期间经食管检查结果与复苏成功之间的关联。
回顾性队列研究。对因难治性院外心脏骤停而被送入急诊室接受体外心肺复苏的患者进行经食管评估右心室分数面积变化、右心室流出道分数缩短、左心室容积、射血分数和主动脉直径。
共分析了 19 名患者。19 名患者中有 15 名（79%）接受了静脉-动脉体外膜氧合支持。在 7 名患者（SUXX 组）中恢复了自主循环或电机械活动，复苏成功，在 12 名患者（FAIL 组）中复苏失败。从心脏骤停到 24 小时有 6 名患者（32%）存活，1 名患者（5%）存活至出院。在 SUXX 组的所有患者和 FAIL 组的 1 名患者中，CPR 期间 LVOT 是开放的（p<0.0002）。LVOT 关闭的患者均未成功复苏。SUXX 组患者的射血分数（p=0.03）、升主动脉直径（p=0.04）和存活率均高于 FAIL 组（p=0.015）。在多变量 Cox 比例模型中，LVOT 开放是与复苏成功相关的唯一变量。
经食管超声心动图在心肺骤停的紧急情况下可能有助于区分复苏成功和失败。
