Brady W, Meldon S, DeBehnke D
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee.
Ann Emerg Med. 1995 Jan;25(1):64-70. doi: 10.1016/s0196-0644(95)70357-8.
Monomorphic ventricular tachycardia (MVT) is the most common form of prehospital ventricular tachycardia (VT). Recent literature suggests that polymorphic ventricular tachycardia (PVT) is more common during cardiopulmonary arrest than previously thought but responds poorly to advanced cardiac life support (ACLS) therapy. We undertook this study to determine the prevalence, response to therapy, and outcome of both MVT and PVT in the prehospital sudden cardiac death victim.
Retrospective prehospital chart review from 1987 to 1991.
Municipal, fire department-based, multitiered emergency medical system serving a population of approximately one million.
Adult patients older than 18 years experiencing prehospital, nontraumatic cardiopulmonary arrest with VT occurring at any time during the resuscitation. VT was defined as PVT if the QRS-complex configuration was not stable when viewed in a single electrocardiographic lead (ie, episodic changing of the QRS-complex electrical axis, amplitude, or both or the presence of more than two QRS-complex morphologies). Outcome was defined in terms of both the presence or absence of spontaneous circulation at the end of the prehospital phase of care and ultimate outcome (survival to hospital discharge or death). Four hundred seventy-six patients met entry criteria; 37 patients were excluded because of incomplete medical records, and 439 patients were used for data analysis.
ACLS therapy based on the 1987 American Heart Association guidelines.
MVT occurred in 323 patients (73.6%), with 119 (36.8%) showing return of spontaneous circulation (ROSC) in the prehospital setting; 35 MVT patients (10.8%) survived to hospital discharge. PVT occurred in 116 patients (26.4%), with 48 (41.4%) showing ROSC in the prehospital setting; 15 PVT patients (12.9%) survived to hospital discharge. The use of ACLS therapy (defibrillation, endotracheal intubation, medication usage) between the two rhythm groups was not statistically different. The P values for ROSC, ultimate outcome, and use of ACLS therapy were all not significant.
We conclude that PVT is a common rhythm occurring in prehospital cardiopulmonary arrest that responds as well as MVT to ACLS therapy. Until prospective data are available, standard ACLS therapy should be used in all forms of prehospital VT occurring during cardiopulmonary arrest.
单形性室性心动过速（MVT）是院外室性心动过速（VT）最常见的形式。近期文献表明，多形性室性心动过速（PVT）在心肺骤停期间比之前认为的更常见，但对高级心脏生命支持（ACLS）治疗反应不佳。我们开展这项研究以确定院外心脏性猝死患者中MVT和PVT的患病率、治疗反应及预后。
对1987年至1991年的院外病历进行回顾性研究。
为约100万人口服务的市级、基于消防部门的多层级紧急医疗系统。
18岁以上的成年患者，经历院外非创伤性心肺骤停，复苏期间任何时间发生VT。若在单导联心电图中观察到QRS波群形态不稳定（即QRS波群电轴、振幅或两者间歇性改变，或存在两种以上QRS波群形态），则VT定义为PVT。结局根据院外护理阶段结束时是否存在自主循环以及最终结局（存活至出院或死亡）来定义。476例患者符合纳入标准；37例因病历不完整被排除，439例患者用于数据分析。
根据1987年美国心脏协会指南进行ACLS治疗。
323例患者发生MVT（73.6%），其中119例（36.8%）在院外出现自主循环恢复（ROSC）；35例MVT患者（10.8%）存活至出院。116例患者发生PVT（26.4%），其中48例（41.4%）在院外出现ROSC；15例PVT患者（12.9%）存活至出院。两组心律之间ACLS治疗（除颤、气管插管、药物使用）的使用情况无统计学差异。ROSC、最终结局及ACLS治疗使用情况的P值均无统计学意义。
我们得出结论，PVT是院外心肺骤停中常见的心律，对ACLS治疗的反应与MVT相同。在获得前瞻性数据之前，对于心肺骤停期间发生的所有形式的院外VT，均应采用标准ACLS治疗。
