Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
Resuscitation. 2022 Oct;179:152-162. doi: 10.1016/j.resuscitation.2022.08.015. Epub 2022 Aug 27.
Ventricular fibrillation (VF) waveform measures reflect myocardial physiologic status. Continuous assessment of VF prognosis using such measures could guide resuscitation, but has not been possible due to CPR artifact in the ECG. A recently-validated VF measure (termed VitalityScore), which estimates the probability (0-100%) of return-of-rhythm (ROR) after shock, can assess VF during CPR, suggesting potential for continuous application during resuscitation.
We evaluated VF using VitalityScore to characterize VF prognostic status continuously during resuscitation.
We characterized VF using VitalityScore during 60 seconds of CPR and 10 seconds of subsequent pre-shock CPR interruption in patients with out-of-hospital VF arrest. VitalityScore utility was quantified using area under the receiver operating characteristic curve (AUC). VitalityScore trends over time were estimated using mixed-effects models, and associations between trends and ROR were evaluated using logistic models. A sensitivity analysis characterized VF during protracted (100-second) periods of CPR.
We evaluated 724 VF episodes among 434 patients. After an initial decline from 0-8 seconds following VF onset, VitalityScore increased slightly during CPR from 8-60 seconds (slope: 0.18%/min). During the first 10 seconds of subsequent pre-shock CPR interruption, VitalityScore declined (slope: -14%/min). VitalityScore predicted ROR throughout CPR with AUCs 0.73-0.75. Individual VitalityScore trends during 8-60 seconds of CPR were marginally associated with subsequent ROR (adjusted odds ratio for interquartile slope change (OR) = 1.10, p = 0.21), and became significant with protracted (100 seconds) CPR duration (OR = 1.28, p = 0.006).
VF prognostic status can be continuously evaluated during resuscitation, a development that could translate to patient-specific resuscitation strategies.
心室颤动 (VF) 波形测量反映了心肌的生理状态。使用此类测量值连续评估 VF 预后可以指导复苏，但由于 CPR 对心电图的干扰，这一直难以实现。最近验证的一种 VF 测量值（称为 VitalityScore），它可以估计电击后恢复节律的概率（0-100%），可在 CPR 期间评估 VF，这表明在复苏期间有可能连续应用。
我们使用 VitalityScore 评估 VF，以在复苏过程中连续描述 VF 的预后状态。
我们在院外 VF 骤停患者的 CPR 持续 60 秒和随后电击前 CPR 中断 10 秒期间使用 VitalityScore 描述 VF。使用接受者操作特征曲线下面积 (AUC) 来量化 VitalityScore 的效用。使用混合效应模型估计 VitalityScore 随时间的趋势，并使用逻辑模型评估趋势与恢复节律之间的关联。一项敏感性分析描述了 CPR 持续 100 秒期间的 VF。
我们评估了 434 名患者中的 724 个 VF 发作。VF 发作后 0-8 秒初始下降后，VitalityScore 在 CPR 期间从 8-60 秒略有增加（斜率：0.18%/min）。在随后电击前 CPR 中断的前 10 秒期间，VitalityScore 下降（斜率：-14%/min）。VitalityScore 在整个 CPR 过程中预测恢复节律的 AUC 值为 0.73-0.75。CPR 期间 VitalityScore 趋势的个体变化与随后的恢复节律略有关联（四分位斜率变化的调整优势比 (OR) = 1.10，p = 0.21），并且在 CPR 持续时间延长（100 秒）时变得显著（OR = 1.28，p = 0.006）。
在复苏过程中可以连续评估 VF 的预后状态，这一发展可能转化为针对患者的复苏策略。
