Department of Emergency Medicine, Yeungnam University School of Medicine and College of Medicine, Daegu, Korea.
Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
Emerg Med J. 2021 Jan;38(1):53-58. doi: 10.1136/emermed-2020-209623. Epub 2020 Oct 26.
Pulseless electrical activity (PEA) is increasingly observed in out-of-hospital cardiac arrest (OHCA), but outcomes are still poor. We aimed to assess the relationship between QRS characteristics and outcomes of patients with OHCA with initial PEA (OHCA-P).
This prospective observational study included patients aged at least 18 years who developed OHCA-P between 1 January 2016 and 31 December 2018, and were enrolled in the Daegu Emergency Medical Services registry, South Korea. We performed multivariable logistic regression analyses to identify the associations between QRS characteristics and OHCA-P outcomes, in which QRS complexes were considered separately (model 1) and simultaneously (model 2). The primary outcome was survival to hospital discharge and the secondary outcome was a favourable neurological outcome.
Of the 3659 patients with OHCA, 576 were enrolled (median age 73 years; 334 men). A higher QRS amplitude was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (adjusted OR (aOR) 1.077 and 1.106, respectively; 95% CI 1.021 to 0.136 and 1.029 to 1.190, respectively) and model 2 (aOR 1.084 and 1.123, respectively; 95% CI 1.026 to 1.145 and 1.036 to 1.216, respectively). A QRS width of <120 ms was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (aOR 3.371 and 4.634, respectively; 95% CI 1.633 to 6.960 and 1.562 to 13.144, respectively) and model 2 (aOR 3.213 and 5.103, respectively; 95% CI 1.568 to 6.584 and 1.682 to 15.482, respectively). Survival to hospital discharge and neurological outcome were not associated with QRS frequency.
OHCA-P outcomes were better when the initial QRS complex showed a higher amplitude or narrower width.
在院外心脏骤停（OHCA）中越来越多地观察到无脉性电活动（PEA），但预后仍然很差。我们旨在评估初始 PEA（OHCA-P）的 OHCA 患者的 QRS 特征与结局之间的关系。
这项前瞻性观察性研究纳入了 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在韩国大邱急救医疗服务登记处登记的至少 18 岁发生 OHCA-P 的患者。我们进行了多变量逻辑回归分析，以确定 QRS 特征与 OHCA-P 结局之间的关系，其中 QRS 复合体分别（模型 1）和同时（模型 2）进行考虑。主要结局是存活至出院，次要结局是良好的神经结局。
在 3659 例 OHCA 患者中，有 576 例入选（中位年龄 73 岁；334 例男性）。在模型 1 中，较高的 QRS 幅度与存活至出院和良好的神经结局相关（校正比值比（aOR）分别为 1.077 和 1.106，95%CI 为 1.021 至 0.136 和 1.029 至 1.190）和模型 2（aOR 分别为 1.084 和 1.123，95%CI 分别为 1.026 至 1.145 和 1.036 至 1.216）。在模型 1 中，QRS 宽度<120ms 与存活至出院和良好的神经结局相关（aOR 分别为 3.371 和 4.634，95%CI 分别为 1.633 至 6.960 和 1.562 至 13.144）和模型 2（aOR 分别为 3.213 和 5.103，95%CI 分别为 1.568 至 6.584 和 1.682 至 15.482）。存活至出院和神经结局与 QRS 频率无关。
初始 QRS 复合波表现出较高的幅度或较窄的宽度时，OHCA-P 的结局更好。
