Yang Jing, Tang Hanqi, Shao Shihuan, Xu Feng, Fu Yangyang, Xu Shengyong, Li Chen, Li Yan, Liu Yang, Walline Joseph Harold, Zhu Huadong, Chen Yuguo, Yu Xuezhong, Xu Jun
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Emergency Department, Peking University People's Hospital, Beijing 100044, China.
World J Emerg Med. 2024;15(1):16-22. doi: 10.5847/wjem.j.1920-8642.2023.186.
Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. This study examined whether end-tidal carbon dioxide (ETCO) and pulse oximetry photoplethysmogram (POP) parameters can be used to identify unsustained ROSC.
We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014. Patients' general information, ETCO, and POP parameters were collected and statistically analyzed.
The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group (29.2% vs. 9.4%, <0.05). The logistic regression analysis showed that the difference between after and before ROSC in ETCO (ΔETCO) and the difference between after and before ROCS in area under the curve of POP (ΔAUCp) were independently associated with sustained ROSC (odds ratio []=0.931, 95% confidence interval [95% ] 0.881-0.984, =0.011 and =0.998, 95% 0.997-0.999, <0.001). The area under the receiver operating characteristic curve of ΔETCO, ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% 0.660-0.844), 0.883 (95% 0.818-0.948), and 0.902 (95% 0.842-0.962), respectively.
Patients with unsustained ROSC have a poor prognosis. The combination of ΔETCO and ΔAUCp showed significant predictive value for unsustained ROSC.
心脏骤停患者中，未持续恢复自主循环（ROSC）是影响生存的关键障碍。本研究探讨了呼气末二氧化碳（ETCO）和脉搏血氧饱和度光电容积脉搏波描记图（POP）参数是否可用于识别未持续恢复自主循环。
我们对2013年至2014年连续的心脏骤停患者进行了一项多中心观察性前瞻性队列研究。收集患者的一般信息、ETCO和POP参数并进行统计分析。
纳入的105次ROSC发作（来自80例心脏骤停患者）包括51次持续ROSC发作和54次未持续ROSC发作。持续ROSC组的24小时生存率显著高于未持续ROSC组（29.2%对9.4%，<0.05）。逻辑回归分析显示，ROSC前后ETCO的差值（ΔETCO）以及ROSC前后POP曲线下面积的差值（ΔAUCp）与持续ROSC独立相关（比值比[]=0.931，95%置信区间[95%]0.881 - 0.984，=0.011；=0.998，95% 0.997 - 0.999，<0.001）。ΔETCO、ΔAUCp及其联合预测未持续ROSC的受试者工作特征曲线下面积分别为0.752（95% 0.660 - 0.844）、0.883（95% 0.818 - 0.948）和0.902（95% 0.842 - 0.962）。
未持续恢复自主循环的患者预后较差。ΔETCO和ΔAUCp的联合对未持续恢复自主循环具有显著的预测价值。
