Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Crit Care Med. 2024 Sep 1;52(9):1367-1379. doi: 10.1097/CCM.0000000000006336. Epub 2024 May 23.
Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at "the center of the chest," ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA.
Prospective observational cohort study.
Single center.
This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings.
None.
The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co2 (Et co2 ) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Et co2 , post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups.
Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.
根据当前心肺复苏（CPR）指南的建议，即推荐在“胸部中心”进行胸外按压，约 50%的院外心脏骤停（OHCA）患者接受主动脉瓣（AV）按压，从而阻碍血流。我们使用复苏性经食管超声心动图（TEE）来阐明未受压与受压的 AV 对成人 OHCA 患者结局的影响。
前瞻性观察队列研究。
单中心。
本研究纳入了在急诊科接受复苏性 TEE 的成年 OHCA 患者。根据 TEE 结果，将患者分为 AV 未受压或 AV 受压组。
无。
主要结局是自主循环（ROSC）的持续恢复。次要结局包括 CPR 期间的呼气末二氧化碳（Et co2 ）、任何 ROSC、存活至 ICU 和出院、复苏后停药以及出院时的良好神经功能结局。还进行了关于心脏骤停期间的动脉血压（ABP）的其他分析。样本量预先估计为每组 37 例。从 2020 年 10 月至 2023 年 1 月，共纳入 76 例患者，AV 未受压组和 AV 受压组分别为 39 例和 37 例。组间基线特征相似。与 AV 受压组相比，AV 未受压组的持续 ROSC （53.8% vs. 24.3%；调整后的优势比[aOR]，4.72；p = 0.010）、任何 ROSC（56.4% vs. 32.4%；aOR，3.30；p = 0.033）和存活至 ICU（33.3% vs. 8.1%；aOR，6.74；p = 0.010）的可能性更高，并且记录到初始舒张期 ABP 更高（33.4 与 11.5 毫米汞柱；p = 0.002），并且在 CPR 期间达到舒张期 ABP 大于 20 毫米汞柱的比例更大（93.8% 与 33.3%；p < 0.001）。Et co2 、复苏后停药和出院时的生存情况在组间无显著差异。没有患者出院时神经功能良好。OHCA 复苏期间 AV 无受压似乎对所有亚组的 ROSC 持续恢复至关重要。
OHCA 复苏期间 AV 无受压与 ROSC 机会增加和存活至 ICU 有关。然而，其对长期结局的影响尚不清楚。
