Hulleman Michiel, Salcido David D, Menegazzi James J, Souverein Patrick C, Tan Hanno L, Blom Marieke T, Koster Rudolph W
Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands.
Resuscitation. 2020 Jun;151:173-180. doi: 10.1016/j.resuscitation.2020.02.027. Epub 2020 Mar 10.
Ventricular fibrillation (VF) waveform analyses are considered a reliable proxy for OHCA characteristics in out-of-hospital cardiac arrest (OHCA), but patient characteristics such as cardiovascular medication use might also be associated with changes in VF waveform measures.
To assess associations between cardiovascular medication use and amplitude spectrum area (AMSA) of VF, while correcting for the presence of cardiovascular disease (CVD), CVD risk factors, and OHCA characteristics.
We included 990 VF patients from an OHCA registry in the Netherlands, with available information on medical history and cardiovascular medication use. Associations between cardiovascular medication use and AMSA were tested in a multivariate linear regression model, adjusting for CVD, CVD risk factors, and OHCA characteristics. Model performance was shown using R-square and R-change. We also calculated whether medication use was associated with faster dissolution of AMSA to lower values with increasing time delay.
In the multivariate analysis, when corrected for CVD, CVD risk factors and OHCA characteristics, only potassium-sparing agents were associated with a lower AMSA when compared to patients using other cardiovascular medications (OR 0.46 [95% CI 0.10-0.81]; P < 0.012). The decrease in AMSA with increasing EMS-call-to-ECG delay was the same for patients with and without cardiovascular medication use (all P > 0.05). Only a small part of the variance in AMSA could be explained by medication use (R-square 0.003- 0.026). Adding OHCA characteristics to the model resulted in the largest R square change (0.09-0.15).
It is unlikely that there is a strong and clinically relevant independent pharmacologic effect of cardiovascular medication use on AMSA. In OHCA, AMSA might be used as patient management tool without considering cardiovascular medication use.
室颤（VF）波形分析被认为是院外心脏骤停（OHCA）中OHCA特征的可靠替代指标，但患者特征，如心血管药物的使用，也可能与VF波形测量的变化有关。
评估心血管药物使用与VF的振幅频谱面积（AMSA）之间的关联，同时校正心血管疾病（CVD）、CVD危险因素和OHCA特征的存在情况。
我们纳入了荷兰一个OHCA登记处的990例VF患者，这些患者有病史和心血管药物使用的可用信息。在多变量线性回归模型中测试心血管药物使用与AMSA之间的关联，并对CVD、CVD危险因素和OHCA特征进行校正。使用决定系数（R平方）和R变化来显示模型性能。我们还计算了药物使用是否与随着时间延迟增加AMSA更快地降至较低值有关。
在多变量分析中，校正CVD、CVD危险因素和OHCA特征后，与使用其他心血管药物的患者相比，只有保钾药物与较低的AMSA相关（比值比0.46 [95%置信区间0.10 - 0.81]；P < 0.012）。无论是否使用心血管药物，随着急救医疗服务呼叫至心电图延迟增加，AMSA的降低情况相同（所有P > 0.05）。药物使用只能解释AMSA中一小部分的变异（决定系数0.003 - 0.026）。将OHCA特征添加到模型中导致最大的R平方变化（0.09 - 0.15）。
心血管药物使用对AMSA不太可能有强烈且具有临床相关性的独立药理作用。在OHCA中，AMSA可作为患者管理工具，而无需考虑心血管药物的使用情况。
