Yang Feihong, Zou Hao, Gan Jiaohong, Zhao Xia, Tu Xiaopeng, Jiang Cheng, Xia Jian
Zhongnan Hospital of Wuhan University, Department of Emergency Medicine, Wuhan, 430071, Hubei, People's Republic of China.
Zhongnan Hospital of Wuhan University, Department of Ultrasound, Wuhan, 430071, Hubei, People's Republic of China.
West J Emerg Med. 2025 May 20;26(3):491-499. doi: 10.5811/westjem.36710.
End-tidal carbon dioxide (EtCO) has been regarded as the gold standard for assessing the effectiveness of cardiopulmonary resuscitation (CPR). However, the clinically observed limitations of EtCO influenced by ventilation during CPR suggest the need to implement a new, non-invasive hemodynamic monitoring method to evaluate and optimize CPR effectiveness in real time.
For this prospective study we enrolled 31 cardiac arrest (CA) patients who presented to the emergency department (ED) and 13 healthy volunteers as point-of-care ultrasound (POCUS) controls. Two physicians not involved in the resuscitation team performed POCUS of the bilateral carotid and femoral arteries during chest compression within the first 10 minutes of CPR. The clinical data and presumed CA cause were recorded. We observed the arterial pulse and measured the peak systolic velocity (PSV). The EtCO values during POCUS were also recorded. We explored the correlation between arterial PSV and EtCO.
The mean age of the patients was 69 ± 2 years, and 22 were male. Of 25 patients who experienced out-of-hospital cardiac arrest, 18 had an average no/low-flow time >30 minutes before ED arrival. Five patients achieved return of spontaneous circulation (ROSC). We found no significant difference in arterial PSV between ROSC and non-ROSC patients. The PSV of the left femoral artery was most consistently and positively correlated with EtCO in CA patients (R 0.35, P=0.003).
Detection of arterial peak systolic velocity by point-of-care ultrasound, especially of the left femoral artery, might be a feasible method for non-invasive, real-time monitoring of chest compression effectiveness during CPR.
呼气末二氧化碳（EtCO）一直被视为评估心肺复苏（CPR）效果的金标准。然而，CPR期间受通气影响的EtCO在临床上观察到的局限性表明，需要实施一种新的非侵入性血流动力学监测方法，以实时评估和优化CPR效果。
在这项前瞻性研究中，我们纳入了31例到急诊科就诊的心脏骤停（CA）患者，并将13名健康志愿者作为床旁超声（POCUS）对照。两名未参与复苏团队的医生在CPR的前10分钟内进行胸外按压时，对双侧颈动脉和股动脉进行了POCUS检查。记录临床数据和推测的CA病因。我们观察动脉搏动并测量收缩期峰值流速（PSV）。同时记录POCUS期间的EtCO值。我们探讨了动脉PSV与EtCO之间的相关性。
患者的平均年龄为69±2岁，其中22例为男性。在25例院外心脏骤停患者中，18例在到达急诊科之前平均无/低血流时间>30分钟。5例患者实现了自主循环恢复（ROSC）。我们发现ROSC患者和未实现ROSC的患者之间动脉PSV无显著差异。在CA患者中左股动脉的PSV与EtCO的相关性最为一致且呈正相关（R=0.35，P=0.003）。
通过床旁超声检测动脉收缩期峰值流速，尤其是左股动脉的流速，可能是一种在CPR期间非侵入性实时监测胸外按压效果的可行方法。
