Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
Ann Emerg Med. 2023 May;81(5):523-531. doi: 10.1016/j.annemergmed.2022.12.002. Epub 2023 Feb 7.
This study explored femoral arterial Doppler during active cardiopulmonary resuscitation (CPR) to identify and characterize the resumptions of cardiac activity without stopping CPR.
This was a proof-of-concept study exploring arterial Doppler during cardiac arrest. Patients in cardiac arrest undergoing active CPR were prospectively enrolled. Arterial Doppler of the common femoral artery was recorded during CPR and during pauses in CPR. CPR-induced arterial tracings and native cardiac-induced tracings were analyzed for rate and peak systolic velocity. Cardiac activity on echocardiogram during pause in CPR was classified as "absent," "disorganized," or "organized." Descriptive data and survival are presented as mean and 95% confidence intervals (CI), as well as sensitivity and specificity of Doppler during active CPR in detecting native cardiac pulsations.
Sixteen patients with 48 paired Doppler recordings during active CPR, pause in CPR, and associated echocardiogram were enrolled. Native cardiac-induced tracings were visible during 39.6% of pauses in CPR (19 of 48) and during 18.8% of the periods of active CPR (9 of 48). Arterial pulsations were more frequently visualized with organized contractions by echocardiogram (10 of 14, 71%) than disorganized contractions (9 of 22, 41%). Arterial Doppler was 100% specific and 50% sensitive in detecting organized cardiac activity during active CPR. Patients with visible native cardiac pulsations during active CPR demonstrated 0% mortality compared with 67% mortality without visible arterial pulsations.
Arterial Doppler tracings may identify the resumption of native cardiac activity during active CPR; however, more research is needed.
本研究旨在探讨主动心肺复苏（CPR）期间的股动脉多普勒，以识别和描述不停止 CPR 时心脏活动的恢复。
这是一项探索心脏骤停期间动脉多普勒的概念验证研究。前瞻性纳入正在接受主动 CPR 的心脏骤停患者。CPR 期间和 CPR 暂停期间记录股总动脉的动脉多普勒。分析 CPR 诱导的动脉迹线和固有心脏诱导的迹线的频率和收缩期峰值速度。CPR 暂停期间超声心动图上的心脏活动分为“无”、“无序”或“有序”。描述性数据和生存情况以平均值和 95%置信区间（CI）表示，以及主动 CPR 期间多普勒检测固有心脏搏动的敏感性和特异性。
纳入了 16 例患者，共有 48 对在主动 CPR、CPR 暂停和相关超声心动图期间的多普勒记录。固有心脏诱导迹线在 39.6%（48 次中有 19 次）的 CPR 暂停期间和 18.8%（48 次中有 9 次）的主动 CPR 期间可见。动脉搏动通过超声心动图更频繁地显示出有组织的收缩（14 次中有 10 次，71%），而不是无序的收缩（22 次中有 9 次，41%）。动脉多普勒在主动 CPR 期间检测有组织的心脏活动时具有 100%的特异性和 50%的敏感性。在主动 CPR 期间可见固有心脏搏动的患者死亡率为 0%，而未见动脉搏动的患者死亡率为 67%。
动脉多普勒迹线可能识别主动 CPR 期间固有心脏活动的恢复；然而，还需要进一步研究。
