Liu Linda, Karatasakis Aris, Kudenchuk Peter J, Kirkpatrick James N, Sayre Michael R, Carlbom David J, Johnson Nicholas J, Probstfield Jeffrey L, Counts Catherine, Branch Kelley R H
University of Washington, Department of Medicine, Seattle, WA, United States.
University of Washington, Division of Cardiology, Seattle, WA, United States.
Resuscitation. 2023 Mar;184:109719. doi: 10.1016/j.resuscitation.2023.109719. Epub 2023 Feb 2.
Current international guidelines recommend early echocardiography after resuscitated sudden death despite limited data. Our aim was to analyze published data on early post-resuscitation echocardiography to identify cardiac causes of sudden death and prognostic implications.
We reviewed MEDLINE, EMBASE, and CENTRAL databases to December 2021 for echocardiographic studies of adult patients after resuscitation from non-traumatic sudden death. Studies were included if echocardiography was performed <48 hours after resuscitation and reported (1) diagnostic accuracy to detect cardiac etiologies of sudden death or (2) prognostic outcomes. Diagnostic endpoints were associations of regional wall motion abnormalities (RWMA), ventricular function, and structural abnormalities with cardiac etiologies of arrest. Prognostic endpoints were associations of echocardiographic findings with survival to hospital discharge and favorable neurological outcome.
Of 2877 articles screened, 16 (0.6%) studies met inclusion criteria, comprising 2035 patients. Two of six studies formally reported diagnostic accuracy for echocardiography identifying cardiac etiology of arrest; RWMA (in 5 of 6 studies) were associated with presumed cardiac ischemia in 17-89% of cases. Among 12 prognostic studies, there was no association of reduced left ventricular ejection fraction with hospital survival (v10) or favorable neurologic status (n = 5). Echocardiographic high mitral E/e' ratio (n = 1) and right ventricular systolic dysfunction (n = 2) were associated with poor survival.
This scoping review highlights the limited data on early echocardiography in providing etiology of arrest and prognostic information after resuscitated sudden death. Further research is needed to refine the clinical application of early echocardiographic findings in post arrest care.
尽管数据有限，但当前国际指南仍推荐对复苏成功的猝死患者尽早进行超声心动图检查。我们的目的是分析已发表的关于复苏后早期超声心动图检查的数据，以确定猝死的心脏原因及其预后意义。
我们检索了截至2021年12月的MEDLINE、EMBASE和CENTRAL数据库，以查找关于非创伤性猝死复苏后成年患者的超声心动图研究。如果超声心动图检查在复苏后<48小时进行，并报告了以下内容，则纳入研究：（1）检测猝死心脏病因的诊断准确性；或（2）预后结果。诊断终点是局部室壁运动异常（RWMA）、心室功能和结构异常与心脏骤停病因的关联。预后终点是超声心动图检查结果与出院存活及良好神经功能结局的关联。
在筛选的2877篇文章中，16项（0.6%）研究符合纳入标准, 共2035例患者。六项研究中有两项正式报告了超声心动图检查确定心脏骤停病因的诊断准确性；RWMA（六项研究中的五项）在17%-89%的病例中与推测的心肌缺血相关。在12项预后研究中，左心室射血分数降低与住院存活（v10）或良好神经功能状态（n = 5）之间无关联。超声心动图检查二尖瓣E/e'比值升高（n = 1）和右心室收缩功能障碍（n = 2）与不良存活相关。
这项范围综述强调了关于复苏后早期超声心动图检查在提供心脏骤停病因和预后信息方面的数据有限。需要进一步研究以完善早期超声心动图检查结果在心脏骤停后护理中的临床应用。
