在院外心脏骤停幸存者的治疗性低温治疗期间体表心电图描记中 J（Osborn）波的预后价值（JOW 试验）。

Prognostic Value of J (Osborn) Waves on Surface Electrocardiogram Tracing during Therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest Survivors (JOW trial).

机构信息

Department of Cardiology, Emek Medical Center, Afula, Israel.

出版信息

Isr Med Assoc J. 2021 May;23(5):291-296.

Abstract

BACKGROUND

Patients admitted to the hospital after successful resuscitation from sudden cardiac death (SCD) are treated with therapeutic hypothermia (TH) to facilitate brain preservation. The prognostic significance of J (Osborn) waves (JOW) in the 12 leads electrocardiogram in this setting has not been elucidated as yet.

OBJECTIVES

To ascertain retrospectively the prognostic significance of JOW recorded during TH in SCD survivors.

METHODS

The study comprised 55 consecutive patients who underwent TH. All patients achieved a core temperature of 33°C at the time of electrocardiogram analysis. We compared 33 patients with JOW to 22 patients without JOW. The endpoints were in-hospital, long-term all-cause mortality, and irreversible anoxic brain injury (IABI).

RESULTS

Patients with JOW compared to patients without JOW were younger (55.1 ± 11.6 vs. 64.5 ± 11.7 years, respectively, P < 0.006), with a lower incidence of hypertension (52% vs. 86%, P < 0.007), diabetes mellitus (15% vs. 50%, P < 0.005), and congestive heart failure (15% vs. 45%, P < 0.013). In-hospital and long-term mortality were significantly higher in patients without JOW (86% vs. 21%, 91% vs. 24%, respectively, P < 0.000001). Among patients without JOW who survived hospitalization, 66.7% presented with IABI versus 7.7% of the patients with JOW (P < 0.0001). In multivariate analysis, the absence of JOW was a significant predictor for poor prognosis.

CONCLUSIONS

The absence of J (Osborn) waves on electrocardiograms obtained during TH is associated with poor prognosis among SCD survivors.

摘要

背景

成功复苏心搏骤停（SCD）的患者在住院期间接受治疗性低温（TH）以促进脑保护。在这种情况下，12 导联心电图中 J（Osborn）波（JOW）的预后意义尚未阐明。

目的

回顾性确定 SCD 幸存者在 TH 期间记录的 JOW 的预后意义。

方法

该研究包括 55 例连续接受 TH 的患者。所有患者在进行心电图分析时核心温度达到 33°C。我们比较了 33 例有 JOW 的患者和 22 例无 JOW 的患者。终点为院内、长期全因死亡率和不可逆性缺氧性脑损伤（IABI）。

结果

与无 JOW 的患者相比，有 JOW 的患者更年轻（55.1 ± 11.6 岁 vs. 64.5 ± 11.7 岁，P < 0.006），高血压发生率较低（52% vs. 86%，P < 0.007），糖尿病（15% vs. 50%，P < 0.005）和充血性心力衰竭（15% vs. 45%，P < 0.013）。无 JOW 的患者院内和长期死亡率明显较高（86% vs. 21%，91% vs. 24%，P < 0.000001）。在无 JOW 存活住院的患者中，66.7%出现 IABI，而有 JOW 的患者为 7.7%（P < 0.0001）。在多变量分析中，缺乏 JOW 是预后不良的显著预测因素。