Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram
Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram
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DOI：
10.1111/j.1553-2712.2001.tb00174.x
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发表时间：
2001-06-01
影响因子：
4.4
通讯作者：
Fox, JC
中科院分区：
文献类型：
--
作者：
Blaivas, M;Fox, JC
心脏骤停的患者通常结局不佳，尽管在现场采取了英勇的复苏措施。许多急救医疗系统都有在现场停止复苏措施的协议;然而，需要为送到急诊室（艾德）的心脏骤停患者开发进一步的预测因素。目的：探讨在接受心肺复苏（CPR）的患者的初始表现期间，床旁艾德超声心动图显示的心脏停顿的预测价值。研究方法：该研究在一家大型城市社区医院进行，该医院有急诊医学住院医师项目和大量心脏骤停患者。作为常规护理的一部分，所有正在进行心肺复苏术的患者都要立即接受简短的剑突下或胸骨旁心脏超声检查。随后在复苏期间检查脉搏时进行简短的重复超声检查。使用2.5 MHz相控阵探头进行成像。调查人员填写了标准化数据表。检查被录音以供审查。统计分析包括描述性统计、阳性和阴性预测值以及似然比。结果：169例患者入组研究。136例患者在初始超声心动图上出现心脏停顿。其中，71例患者在监测仪上可识别心律。无论患者最初的电节律如何，超声检查发现心脏停搏的患者无一存活离开艾德。超声心动图显示心脏停止导致艾德死亡的阳性预测值为100%，阴性预测值为58%。结论：床旁超声心动图显示心脏停搏的患者无论其电节律如何，都无法存活离开艾德。无论停机时间如何，这一发现都是一致的。虽然需要更大规模的研究，但这可能是停止复苏努力的另一个标志。
Patients presenting in cardiac arrest frequently have poor outcomes despite heroic resuscitative measures in the field. Many emergency medical systems have protocols in place to stop resuscitative measures in the field; however, further predictors need to be developed for cardiac arrest patients brought to the emergency department (ED). Objective: To examine the predictive value of cardiac standstill visualized on bedside ED echocardiograms during the initial presentations of patients receiving cardiopulmonary resuscitation (CPR). Methods: The study took place in a large urban community hospital with an emergency medicine residency program and a high volume of cardiac arrest patients. As part of routine care, all patients arriving with CPR in progress were subject to immediate and brief subxiphoid or parasternal cardiac ultrasound examination. This was followed by brief repeat ultrasound examination during the resuscitation when pulses were checked. A 2.5-MHz phased-array probe was used for imaging. Investigators filled out standardized data sheets. Examinations were taped for review. Statistical analysis included descriptive statistics, positive and negative predictive values, and likelihood ratios. Results: One hundred sixty-nine patients were enrolled in the study. One hundred thirty-six patients had cardiac standstill on the initial echocardiogram. Of these, 71 patients had an identifiable rhythm on monitor. No patient with sonographically identified cardiac standstill survived to leave the ED regardless of his or her initial electrical rhythm. Cardiac standstill on echocardiogram resulted in a positive predictive value of 100% for death in the ED, with a negative predictive value of 58%. Conclusions: Patients presenting with cardiac standstill on bedside echocardiogram do not survive to leave the ED regardless of their electrical rhythms. This finding was uniform regardless of downtime. Although larger studies are needed, this may be an additional marker for cessation of resuscitative efforts.