Chou Eric H, Wang Chih-Hung, Monfort Ralph, Likourezos Antonios, Wolfshohl Jon, Lu Tsung-Chien, Hsieh Yu-Lin, Haines Lawrence, Dickman Eitan, Lin Judy
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States; Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX, United States.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Resuscitation. 2020 Apr;149:74-80. doi: 10.1016/j.resuscitation.2020.02.004. Epub 2020 Feb 14.
To determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED).
This was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHO related. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes.
From January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5 s (IQR: 54.0-160.0 s). Among these, a median of 26.5 s (IQR: 0.0-59.0 s) was ECHO-related and a median of 60.5 s (IQR: 34.0-101.9) was non-ECHO-related. The ECHO-related no-flow time between 77 and 122 s (OR: 7.31, 95 % confidence interval [CI]: 1.59-33.59; p-value = 0.01) and ECHO-related interruption ≦ 2 times (OR: 8.22, 95% CI: 1.51-44.64; p-value = 0.01) were positively associated with survival to hospital discharge. ECHO-related interruption ≦ 2 times (OR: 5.55, 95% CI: 2.44-12.61; p-value < 0.001) was also positively associated with ROSC.
Short ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.
确定急诊科（ED）心肺复苏（CPR）期间经胸超声心动图（ECHO）相关的中断与患者预后之间的关联。
这是一项在城市社区教学急诊科进行的回顾性单中心队列研究。符合条件的研究对象为急诊科持续心脏骤停的成年患者。排除标准包括创伤性心脏骤停和年龄小于18岁。所有复苏过程均进行视频记录，随后由2名研究人员进行回顾。通过视频回顾分析胸外按压中断的无血流时间，并分为与ECHO相关和与ECHO无关两类。我们的主要结局是患者存活至出院，次要结局是自主循环恢复（ROSC）率。进行多因素逻辑回归分析以检验自变量与结局之间的关联。
2016年1月至2017年5月，共有210例患者纳入最终分析。视频中观察到的总无血流时间中位数为99.5秒（四分位间距：54.0 - 160.0秒）。其中，与ECHO相关的无血流时间中位数为26.5秒（四分位间距：0.0 - 59.0秒），与ECHO无关的无血流时间中位数为60.5秒（四分位间距：34.0 - 101.9秒）。77至122秒之间与ECHO相关的无血流时间（比值比：7.31，95%置信区间[CI]：1.59 - 33.59；p值 = 0.01）以及与ECHO相关的中断次数≤2次（比值比：8.22，95% CI：1.51 - 44.64；p值 = 0.01）与存活至出院呈正相关。与ECHO相关的中断次数≤2次（比值比：5.55，95% CI：2.44 - 12.61；p值 < 0.001）也与ROSC呈正相关。
CPR期间与ECHO相关的短暂中断与ROSC及存活至出院呈正相关。虽然ECHO在CPR期间可以是一种有价值的诊断工具，但与ECHO相关的无血流时间应减至最短。
