Kim Tae Youn, Kim Soyeong, Han Sang Il, Hwang Sung Oh, Jung Woo Jin, Roh Young Il, Cha Kyoung-Chul
Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 10326 Goyang, Republic of Korea.
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea.
Rev Cardiovasc Med. 2023 Jul 12;24(7):198. doi: 10.31083/j.rcm2407198. eCollection 2023 Jul.
Gastric inflation (GI) can induce gastric regurgitation and subsequent aspiration pneumonia, which can prolong intensive care unit stay. However, it has not been verified in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the incidence of GI during prehospital resuscitation and its effect on aspiration pneumonia and resuscitation outcomes in patients with out-of-hospital cardiac arrest.
This was a multicenter, retrospective, observational study. Patients with non-traumatic OHCA aged 19 years who had been admitted to the emergency department were enrolled. Patients who received mouth-to-mouth ventilation during bystander cardiopulmonary resuscitation (CPR) were excluded from the evaluation owing to the possibility of GI following bystander CPR. Patients who experienced cardiac arrest during transportation to the hospital who were treated by the emergency medical service (EMS) personnel, and those with a nasogastric tube at the time of chest or abdominal radiography were also excluded. Radiologists independently reviewed plain chest or abdominal radiographs immediately after resuscitation to identify GI. Chest computed tomography performed within 24 h after return of spontaneous circulation was also reviewed to identify aspiration pneumonia.
Of 499 patients included in our analysis, GI occurred in approximately 57% during the prehospital resuscitation process, and its frequency was higher in a bag-valve mask ventilation group (n = 70, 69.3%) than in the chest compression-only cardiopulmonary resuscitation (n = 31, 55.4%), supraglottic airway (n = 180, 53.9%), and endotracheal intubation groups (n = 3, 37.5%) ( = 0.031). GI was inversely associated with initial shockable rhythm (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.30-0.94). Aspiration pneumonia was not associated with GI. Survival to hospital discharge and favorable neurologic outcomes were not associated with GI during prehospital resuscitation.
GI in patients with OHCA was not associated with the use of different airway management techniques.
胃扩张（GI）可导致胃反流及随后的吸入性肺炎，这可能延长重症监护病房住院时间。然而，在院外心脏骤停（OHCA）患者中尚未得到证实。本研究旨在调查院外复苏期间胃扩张的发生率及其对院外心脏骤停患者吸入性肺炎和复苏结局的影响。
这是一项多中心、回顾性、观察性研究。纳入急诊科收治的19岁及以上非创伤性院外心脏骤停患者。因旁观者心肺复苏（CPR）后可能发生胃扩张，排除在旁观者心肺复苏期间接受口对口通气的患者。排除在转运至医院期间发生心脏骤停且由紧急医疗服务（EMS）人员治疗的患者，以及胸部或腹部X线摄影时带有鼻胃管的患者。放射科医生在复苏后立即独立复查胸部或腹部平片以确定胃扩张。还复查了自主循环恢复后24小时内进行的胸部计算机断层扫描以确定吸入性肺炎。
在我们分析的499例患者中，约57%在院外复苏过程中发生胃扩张，其发生率在袋阀面罩通气组（n = 70，69.3%）高于单纯胸外按压心肺复苏组（n = 31，55.4%）、声门上气道组（n = 180，53.9%）和气管插管组（n = 3，37.5%）（P = 0.031）。胃扩张与初始可电击心律呈负相关（调整后的优势比[OR] 0.53；95%置信区间[CI]：0.30 - 0.94）。吸入性肺炎与胃扩张无关。院外复苏期间胃扩张与出院存活及良好的神经功能结局无关。
院外心脏骤停患者的胃扩张与不同气道管理技术的使用无关。
