Drumheller Byron C, Pinizzotto Joseph, Overberger Ryan C, Sabolick Erin E
Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia, 5501 Old York Rd, Philadelphia, PA 19141, United States.
Resusc Plus. 2021 Aug 25;7:100159. doi: 10.1016/j.resplu.2021.100159. eCollection 2021 Sep.
To describe the feasibility of prospective measurement of intra-arrest diastolic blood pressure (DBP) and goal-directed treatment of refractory out-of-hospital cardiac arrest (OHCA) in the emergency department (ED).
Retrospective case series performed at an urban, tertiary-care hospital from 12/1/2018 - 12/31/2019. We studied consecutive adults presenting with refractory, non-traumatic OHCA treated with haemodynamic-targeted resuscitation that entailed placement of a femoral arterial catheter, transduction of continuous BP during CPR, and administration of vasopressors (1 mg noradrenaline) and, if applicable, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), to achieve DBP ≥ 40 mmHg. Feasibility was measured by the success rate and time to achieve arterial catheterization and BP transduction. Additional outcomes included the change in DBP with vasopressor administration and occurrence of sustained ROSC.
Goal-directed treatment was successfully performed in 8/9 (89%) patients. Arterial access required 1.5 (interquartile range (IQR) 1-2) attempts and BP transduction occurred within 10.5 ± 2.4 minutes of patient arrival. Noradrenaline slightly increased DBP (pre 21.6 ± 8.3 mmHg, post 26.1 ± 12.1 mmHg, p < 0.025), but only 4/23 (17%) doses resulted in DBP ≥ 40 mmHg. REBOA was attempted in 2/8 (25%) patients and placed successfully in both cases. Three (37.5%) patients achieved ROSC, but none survived to hospital discharge.
In ED patients with refractory OHCA, measurement of DBP during CPR and titration of resuscitation to a DBP goal is feasible. Future research incorporating this approach should seek to develop haemodynamic-targeted treatment strategies for OHCA patients that do not achieve ROSC with initial resuscitation.
描述在急诊科前瞻性测量心脏骤停期间舒张压（DBP）以及对难治性院外心脏骤停（OHCA）进行目标导向治疗的可行性。
于2018年12月1日至2019年12月31日在一家城市三级医院进行回顾性病例系列研究。我们研究了连续出现难治性、非创伤性OHCA并接受血流动力学靶向复苏治疗的成年患者，该治疗包括放置股动脉导管、在心肺复苏期间连续监测血压以及使用血管升压药（1mg去甲肾上腺素），如适用，还包括进行主动脉内复苏性球囊阻断术（REBOA），以实现DBP≥40mmHg。通过动脉导管插入术和血压监测的成功率及所需时间来衡量可行性。其他结果包括使用血管升压药后DBP的变化以及持续性自主循环恢复（ROSC）的发生情况。
8/9（89%）的患者成功进行了目标导向治疗。动脉穿刺平均需要1.5次（四分位数间距（IQR）为1 - 2次）尝试，血压监测在患者到达后10.5±2.4分钟内完成。去甲肾上腺素使DBP略有升高（用药前21.6±8.3mmHg，用药后26.1±12.1mmHg，p<0.025），但仅4/23（17%）的剂量能使DBP≥40mmHg。2/8（25%）的患者尝试了REBOA，两例均成功放置。3例（37.5%）患者实现了ROSC，但无一例存活至出院。
对于急诊科难治性OHCA患者，在心肺复苏期间测量DBP并将复苏滴定至DBP目标是可行的。纳入这种方法的未来研究应致力于为难治性OHCA患者制定血流动力学靶向治疗策略，这些患者在初始复苏时未实现ROSC。
