Ho Yi-Ju, Lien Chun-Ju, Tsai Ren-Jie, Fan Cheng-Yi, Chen Chi-Hsin, Huang Chien-Tai, Chen Ching-Yu, Chen Yun-Chang, Huang Chun-Hsiang, Chiang Wen-Chu, Huang Chien-Hua, Sung Chih-Wei, Huang Edward Pei-Chuan
Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.
Eur J Emerg Med. 2025 Apr 1;32(2):131-140. doi: 10.1097/MEJ.0000000000001181. Epub 2024 Sep 16.
Out-of-hospital cardiac arrest (OHCA) poses major public health issues. Pre-arrest heart function is a prognostic factor, but the specific contribution of pre-arrest echocardiographic evaluation in predicting OHCA outcome remains limited.
The primary objective was to investigate the association between left ventricular ejection fraction (LVEF) measured in echocardiography prior to OHCA and survival to hospital discharge.
DESIGN, SETTINGS, AND PARTICIPANTS: This multicenter retrospective cohort study analyzed data from the National Taiwan University Hospital and its affiliated hospitals. We included adult nontraumatic OHCA patients who were treated by the emergency medical services (EMS) and underwent echocardiography within 6 months prior to the OHCA event from January 2016 to December 2022. Data included demographics, preexisting diseases, resuscitation events, and echocardiographic reports.
The primary outcome was the survival to hospital discharge after post-arrest care. Statistical analysis involved multivariable logistic regression to modify potential confounders, reported as adjusted odds ratio (aOR) and 95% confidence interval (CI), and evaluate the association between echocardiographic findings and survival to hospital discharge.
This study analyzed 950 patients, with 33.6% surviving to discharge. A higher pre-arrest LVEF was independently associated with increased survival. Compared to patients with LVEF < 40%, those with LVEF between 40% and 60% had significantly higher odds of survival (aOR = 3.68, 95% CI = 2.14-6.35, P < 0.001), and those with LVEF > 60% had even greater odds of survival (aOR = 5.46, 95% CI = 3.09-9.66, P < 0.001). There was also an association between lower tricuspid regurgitation pressure gradient and survival (aOR = 0.98, 95% CI = 0.97-1.00, P = 0.015). Younger age, male gender, dyslipidemia, stroke, cancer, witnessed arrest, initial shockable rhythm, and shorter low-flow time are other significant predictors of survival.
In adult, nontraumatic, EMS-treated OHCA patients, a higher LVEF 6 months prior to OHCA was associated with improved survival at hospital discharge.
院外心脏骤停（OHCA）构成了重大的公共卫生问题。心脏骤停前的心功能是一个预后因素，但心脏骤停前超声心动图评估在预测OHCA结局方面的具体作用仍然有限。
主要目的是研究OHCA前超声心动图测量的左心室射血分数（LVEF）与出院存活率之间的关联。
设计、设置和参与者：这项多中心回顾性队列研究分析了台湾大学附属医院及其分院的数据。我们纳入了2016年1月至2022年12月期间由紧急医疗服务（EMS）治疗且在OHCA事件发生前6个月内接受过超声心动图检查的成年非创伤性OHCA患者。数据包括人口统计学信息、既往疾病、复苏事件和超声心动图报告。
主要结局是心脏骤停后护理后的出院存活率。统计分析采用多变量逻辑回归来调整潜在混杂因素，以调整优势比（aOR）和95%置信区间（CI）报告，并评估超声心动图检查结果与出院存活率之间的关联。
本研究分析了950例患者，其中33.6%存活出院。较高的心脏骤停前LVEF与存活率增加独立相关。与LVEF<40%的患者相比，LVEF在40%至60%之间的患者存活几率显著更高（aOR = 3.68，95%CI = 2.14 - 6.35，P < 0.001），而LVEF>60%的患者存活几率更高（aOR = 5.46，95%CI = 3.09 - 9.66，P < 0.001）。较低的三尖瓣反流压力梯度与存活率之间也存在关联（aOR = 0.98，95%CI = 0.97 - 1.00，P = 0.015）。年龄较小、男性、血脂异常、中风、癌症、目睹心脏骤停、初始可电击心律以及较短的低血流时间是其他存活的重要预测因素。
在成年非创伤性、由EMS治疗的OHCA患者中，OHCA前6个月较高的LVEF与出院时存活率提高相关。
