呼气末 CO 和脑氧饱和度在心肺复苏中预测自主循环恢复的应用。
End tidal CO and cerebral oximetry for the prediction of return of spontaneous circulation during cardiopulmonary resuscitation.
机构信息
Cook County Hospital Department of Emergency Medicine, 1420 W Erie St. APT 2 R, Chicago IL, 60642, United States.
Central Michigan University College of Medicine, 2229 Whitemore Pl., Saginaw, MI, 48602, United States.
出版信息
Resuscitation. 2019 Jun;139:174-181. doi: 10.1016/j.resuscitation.2019.04.006. Epub 2019 Apr 9.
BACKGROUND
End Tidal CO (ETCO) is a reasonable predictor of Return of Spontaneous Circulation (ROSC) in cardiac arrest (CA), though with many limitations. Cerebral Oximetry (CerOx) non-invasively measures brain O saturation and correlates with flow.
OBJECTIVES
This study compares ETCO and CerOx for ROSC prediction during both out of hospital (OHCA) and emergency department cardiac arrests (EDCA).
METHODS
We conducted a prospective study on CA patients resuscitated in the ED. ETCO and CerOx simultaneously measured during ED CPR. Data was analyzed with logistic regression modeling and area under the curve (AUC).
RESULTS
176 patients were analyzed, 66.7% were witnessed, 52.8% had bystander CPR. EMS alert to ED arrival was 27.0 ± 10.6 min. Initial rhythm was 31.8% asystole, 27.8% PEA, 25.6% VF/VT with 26.1% achieving ROSC. AUC predictors of ROSC were: last 5 min trend [CerOx = 0.82 ; ETCO = 0.74], delta first to last [CerOx = 0.86 ; ETCO = 0.73], the penultimate minute [CerOx = 0.81 ; ETCO = 0.76], and final minute [CerOx = 0.89 ; ETCO = 0.77]. AUC comparison of simultaneous measurements (n = 125) revealed: last 5 min trend [CerOx = 0.80 ; ETCO = 0.79], delta first to last [CerOx = 0.83 ; ETCO = 0.75], penultimate minute [CerOx = 0.83 ETCO = 0.74], and final minute [CerOx = 0.89 ; ETCO = 0.75].
CONCLUSIONS
Our data shows, both ETCO2 and rSO2 are good predictors of ROSC. We found CerOx superior to ETCO in predicting ROSC.
背景
在心脏骤停 (CA) 中，潮气末二氧化碳 (ETCO) 是预测自主循环恢复 (ROSC) 的合理指标，但存在许多局限性。脑氧饱和度 (CerOx) 无创测量脑氧饱和度并与血流相关。
目的
本研究比较了 ETCO 和 CerOx 在院外 (OHCA) 和急诊科心脏骤停 (EDCA) 中预测 ROSC 的能力。
方法
我们对在急诊科复苏的 CA 患者进行了一项前瞻性研究。在 EDCPR 期间同时测量 ETCO 和 CerOx。使用逻辑回归模型和曲线下面积 (AUC) 对数据进行分析。
结果
共分析了 176 例患者，66.7%为目击者，52.8%有旁观者 CPR。EMS 从接到警报到到达 ED 的时间为 27.0±10.6 分钟。初始节律为 31.8%的停搏，27.8%的心电机械分离，25.6%的室颤/室速，26.1%达到 ROSC。预测 ROSC 的 AUC 预测因素为：最后 5 分钟趋势[CerOx=0.82；ETCO=0.74]，第一到最后一次的差值[CerOx=0.86；ETCO=0.73]，倒数第二分钟[CerOx=0.81；ETCO=0.76]，最后一分钟[CerOx=0.89；ETCO=0.77]。同时测量的 AUC 比较（n=125）显示：最后 5 分钟趋势[CerOx=0.80；ETCO=0.79]，第一到最后一次的差值[CerOx=0.83；ETCO=0.75]，倒数第二分钟[CerOx=0.83 ETCO=0.74]，最后一分钟[CerOx=0.89；ETCO=0.75]。
结论
我们的数据表明，ETCO2 和 rSO2 都是 ROSC 的良好预测指标。我们发现 CerOx 在预测 ROSC 方面优于 ETCO。
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