在院外心脏骤停患者的院前复苏期间使用近红外光谱监测组织氧合指数：一项初步研究。
Monitoring tissue oxygenation index using near-infrared spectroscopy during pre-hospital resuscitation among out-of-hospital cardiac arrest patients: a pilot study.
机构信息
Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, 216-8511, Kawasaki, Kanagawa, Japan.
Emergency Medicine, Thomas Jefferson University, 1020 Walnut Street, 19107, PA, Philadelphia, USA.
出版信息
Scand J Trauma Resusc Emerg Med. 2021 Mar 4;29(1):42. doi: 10.1186/s13049-021-00857-7.
BACKGROUND
Tissue oxygenation index (TOI) using the near infrared spectroscopy (NIRS) has been demonstrated as a useful indicator to predict return of spontaneous circulation (ROSC) among out-of-hospital cardiac arrest (OHCA) patients in hospital setting. However, it has not been widely examined based on pre-hospital setting.
METHODS
In this prospective observational study, we measured TOI in pre-hospital setting among OHCA patients receiving cardio-pulmonary resuscitation (CPR) during ambulance transportation between 2017 and 2018. Throughout the pre-hospital CPR procedure, TOI was continuously measured. The study population was divided into two subgroups: ROSC group and non-ROSC group.
RESULTS
Of the 81 patients included in the final analysis, 26 achieved ROSC and 55 did not achieve ROSC. Patients in the ROSC group were significantly younger, had higher ∆TOI (changes in TOI) (5.8 % vs. 1.3 %; p < 0.01), and were more likely to have shockable rhythms and event witnessed than patients in the non-ROSC group. ∆TOI cut-off value of 5 % had highest sensitivity (65.4 %) and specificity (89.3 %) for ROSC. Patients with a cut-off value ≤-2.0 % did not achieve ROSC and while all OHCA patient with a cut-off value ≥ 8.0 % achieved ROSC. In addition, ROSC group had stronger positive correlation between mean chest compression rate and ∆TOI (r = 0.82) than non-ROSC group (r = 0.50).
CONCLUSIONS
This study suggests that ∆ TOI could be a useful indicator to predict ROSC in a pre-hospital setting.
背景
近红外光谱（NIRS）的组织氧合指数（TOI）已被证明是预测医院外心脏骤停（OHCA）患者自主循环恢复（ROSC）的有用指标。然而，它在院外环境中尚未得到广泛研究。
方法
在这项前瞻性观察性研究中，我们在 2017 年至 2018 年期间，在救护车转运期间对接受心肺复苏（CPR）的 OHCA 患者进行了院外环境中的 TOI 测量。在整个院外 CPR 过程中，连续测量 TOI。研究人群分为两个亚组：ROSC 组和非 ROSC 组。
结果
在最终分析的 81 例患者中，26 例实现了 ROSC，55 例未实现 ROSC。ROSC 组患者明显更年轻，TOI 变化（∆TOI）更高（5.8%对 1.3%；p<0.01），且更有可能出现可除颤节律和目击者事件，而非 ROSC 组患者则较少。∆TOI 截断值为 5%时对 ROSC 具有最高的敏感性（65.4%）和特异性（89.3%）。截断值≤-2.0%的患者未实现 ROSC，而所有截断值≥8.0%的 OHCA 患者均实现了 ROSC。此外，ROSC 组的平均胸外按压率与 ∆TOI 之间的相关性更强（r=0.82），而非 ROSC 组（r=0.50）。
结论
本研究表明，∆TOI 可能是预测院外环境中 ROSC 的有用指标。
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