Havranek Stepan, Neuhöfer Jakub, Vesela Michaela, Kavalkova Petra, Rob Daniel, Fingrova Zdenka, Smalcova Jana, Franek Ondrej, Huptych Michal, Dusik Milan, Pudil Jan, Weiss Vojtech, Linhart Ales, Belohlavek Jan
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
Emergency Medical Service Prague, Prague, Czech Republic.
Crit Care Med. 2025 Jul 16. doi: 10.1097/CCM.0000000000006787.
A Prague out-of-hospital cardiac arrest (OHCA) study has demonstrated that an invasive approach (early transport to the hospital, extracorporeal cardiopulmonary resuscitation [ECPR]) is a feasible and effective treatment strategy in refractory OHCA. This post hoc analysis of the Prague OHCA study aimed to stratify the prognosis of patients according to the detailed course of heart rhythm during prehospital and early hospital periods.
DESIGN, SETTING, AND PATIENTS: This analysis included all 256 patients (median age 58, 17% females) randomized to the Prague OHCA study. The sequence of heart rhythms during the prehospital period was analyzed in terms of neurologic outcomes after 180 days. The primary outcome was a composite of survival with Cerebral Performance Category 1 or 2 at 180 days.
None.
Within the study cohort, 156 (61%) manifested ventricular fibrillation (VF), 45 pulseless electrical activity, and 55 asystole as the initial rhythm. Patients with an initial VF who reached a sustained recovery of spontaneous circulation (ROSC) had the highest proportion of reaching a primary outcome (32/44 [73%]). Patients who had one or more episodes of asystole during cardiopulmonary resuscitation had the lowest rate of primary endpoint (5/39 [13%]). Patients who experienced intermittent ROSC showed a higher success rate in achieving the primary outcome when treated with an invasive-based approach (including ECPR) compared with the conventional strategy (26/34 [76%] vs. 24/50 [48%]; p < 0.05).
Achieving ROSC is the best prognostic marker in OHCA patients with an initially refractory VF. Patients with intermittent ROSC after the initial VF and ongoing VF seem to be optimal candidates for an invasive approach. Asystole detection at any time during resuscitation is a strong negative prognostic marker, irrespective of the initial rhythm.
一项布拉格院外心脏骤停（OHCA）研究表明，侵入性治疗方法（早期转运至医院、体外心肺复苏[ECPR]）是难治性OHCA的一种可行且有效的治疗策略。这项对布拉格OHCA研究的事后分析旨在根据院前和早期院内阶段心律的详细过程对患者的预后进行分层。
设计、设置和患者：该分析纳入了随机分组至布拉格OHCA研究的所有256例患者（中位年龄58岁，17%为女性）。根据180天后的神经学结局分析了院前阶段的心律序列。主要结局是180天时脑功能分类为1或2级的存活。
无。
在研究队列中，156例（61%）最初表现为心室颤动（VF），45例为无脉电活动，55例为心脏停搏。最初为VF且实现自主循环持续恢复（ROSC）的患者达到主要结局的比例最高（32/44[73%]）。在心肺复苏期间有一次或多次心脏停搏发作的患者达到主要终点的比例最低（5/39[13%]）。与传统策略相比，经历间歇性ROSC的患者采用侵入性治疗方法（包括ECPR）时实现主要结局的成功率更高（26/34[76%]对24/50[48%]；p<0.05）。
在最初为难治性VF的OHCA患者中，实现ROSC是最佳的预后标志物。最初VF后出现间歇性ROSC且持续VF的患者似乎是侵入性治疗方法的最佳候选者。复苏期间任何时候检测到心脏停搏都是一个强烈的不良预后标志物，无论初始心律如何。
