可电击心律能否识别无血流时间短的院外心脏骤停患者？
Can a Shockable Initial Rhythm Identify Out-of-Hospital Cardiac Arrest Patients with a Short No-flow Time?
作者信息
Cournoyer Alexis, de Montigny Luc, Potter Brian J, Segal Eli, Chauny Jean-Marc, Lamarche Yoan, Cossette Sylvie, Morris Judy, Albert Martin, Denault André, Paquet Jean, Marquis Martin, Daoust Raoul
机构信息
Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, Montréal, Québec, Canada; Hôpital Maisonneuve-Rosemont, CIUSSS-EIM, Montréal, Québec, Canada; Corporation d'Urgences-santé, Montréal, Québec, Canada.
Corporation d'Urgences-santé, Montréal, Québec, Canada.
出版信息
Resuscitation. 2021 Jan;158:57-63. doi: 10.1016/j.resuscitation.2020.11.012. Epub 2020 Nov 19.
AIMS
Initial shockable rhythms may be a marker of shorter duration between collapse and initiation of cardiopulmonary resuscitation, known as no-flow time (NFT), for patients suffering an out-of-hospital cardiac arrest (OHCA). Eligibility for extracorporeal resuscitation is conditional on a short NFT. Patients with an unwitnessed OHCA could be candidate for extracorporeal resuscitation despite uncertain NFT if an initial shockable rhythm is a reliable stand-in. Herein, we sought to describe the sensitivity and specificity of an initial shockable rhythm for predicting a NFT of five minutes or less.
METHODS
Using a registry of OHCA in Montreal, Canada, adult patients who experienced a witnessed non-traumatic OHCA, but who did not receive bystander cardiopulmonary resuscitation, were included. The sensitivity and specificity of an initial shockable rhythm for predicting a NFT of five minute or less were calculated. The association between the NFT and the presence of a shockable rhythm was evaluated using a multivariable logistic regression.
RESULTS
A total of 2450 patients were included, of whom 863 (35%) had an initial shockable rhythm and 1085 (44%) a NFT of five minutes or less. The sensitivity of an initial shockable rhythm to predict a NFT of five minutes or less was 36% (95% confidence interval [95%CI] 33-39), specificity was 66% (95%CI 63-68), the positive likelihood ratio was 1.05 (95%CI 0.94-1.17) and the negative likelihood ratio of 0.97 (95%CI 0.92-1.03). The probabilities of observing a shockable rhythm stayed stable up to 15 minutes, while the probabilities of observing a PEA lowered rapidly initially. Longer NFT were associated with lower odds of observing an initial shockable rhythm (adjusted odds ratio = 0.97 [95%CI 0.94-0.99], p = 0.012).
CONCLUSIONS
An initial shockable rhythm is a poor predictor of a short NFT, despite there being an association between the NFT and the presence of a shockable rhythm.
目的
对于院外心脏骤停（OHCA）患者，初始可电击心律可能是心脏骤停至开始心肺复苏之间持续时间较短的一个标志，即所谓的无血流时间（NFT）。体外复苏的适用条件是NFT较短。对于未被目击的OHCA患者，如果初始可电击心律是一个可靠的替代指标，那么尽管NFT不确定，也可能是体外复苏的候选对象。在此，我们试图描述初始可电击心律预测NFT≤5分钟的敏感性和特异性。
方法
利用加拿大蒙特利尔市OHCA登记处的数据，纳入经历过目击非创伤性OHCA但未接受旁观者心肺复苏的成年患者。计算初始可电击心律预测NFT≤5分钟的敏感性和特异性。使用多变量逻辑回归评估NFT与可电击心律之间的关联。
结果
共纳入2450例患者，其中863例（35%）有初始可电击心律，1085例（44%）NFT≤5分钟。初始可电击心律预测NFT≤5分钟的敏感性为36%（95%置信区间[95%CI]33 - 39），特异性为66%（95%CI 63 - 68），阳性似然比为1.05（95%CI 0.94 - 1.17），阴性似然比为0.97（95%CI 0.92 - 1.03）。观察到可电击心律的概率在15分钟内保持稳定，而观察到心搏骤停后无脉电活动（PEA）的概率最初迅速下降。较长的NFT与观察到初始可电击心律的较低几率相关（调整后的优势比=0.97[95%CI 0.94 - 0.99]，p = 0.012）。
结论
尽管NFT与可电击心律之间存在关联，但初始可电击心律对短NFT的预测能力较差。
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