Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest
Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest
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DOI：
10.1080/10903127.2020.1828518
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发表时间：
2020-10-22
影响因子：
2.4
通讯作者：
Renkiewicz, Ginny K.
中科院分区：
文献类型：
--
作者：
Hubble, Michael W.;Van Vleet, Lee;Renkiewicz, Ginny K.
心室颤动（ventricular fibrillation，VF）患者的存活率每分钟下降7%-10%，直至成功除颤。当VF持续时间延长时，缺血心肌的立即除颤不太可能导致ROSC，并且反复不成功的除颤与复苏后心肌功能障碍相关。因此，除颤的时机应该基于电击成功的概率-VF持续时间的函数。不幸的是，VF持续时间往往是未知的在院外心脏骤停（OHCA）和一个更好的预测休克的成功是need. ObjectiveAssessment潮气末二氧化碳（EtCO 2）预测成功除颤OHCA.MethodsThis回顾性研究的能力包括成人患者在四个EMS系统经历了非创伤性OHCA从2015年8月至2017年7月，并收到一个或多个除颤。第一次冲击和后续冲击分别进行了分析。第一次电击表示EMS尝试对之前未接受AED电击的患者进行除颤，而后续电击包括第一次电击之后的所有电击。Logistic回归提供的优势比（OR）的第一次冲击导致ROSC，而一个广义的估计方程被用来分析successentshocks.ResultsAmong 324例患者，869次电击EMS（153第一次和716 successentshocks）。48.1%的病例进行了非专业人员CPR，21.6%的病例在EMS到达前接受了AED电击。非专业人员CPR（OR = 4.41;p = 0.01）和EtCO 2增加（OR = 1.03/mmHg;p = 0.01）更可能发生首次除颤ROSC。其他变量均无统计学显著性。值得注意的是，只有一名EtCO 2 < 20 mmHg的患者在第一次电击时成功除颤。当提供非专业人员CPR时，随着EtCO 2值的增加，ROSC的概率更高，但在没有非专业人员CPR的情况下，在EtCO 2>= 20 mmHg的所有值中保持相对不变。对于那些有/没有外行CPR的人，第一次电击的最佳阈值EtCO 2分别为27和32 mmHg。EtCO 2是不是一个预测ROSC为succedentshocks. ConclusionsA最佳除颤阈值EtCO 2为27和32毫米汞柱的患者，观察和没有外行CPR，分别。进一步的研究是必要的，以验证这些结果，并评估延迟除颤的临床效果，有利于胸外按压，直到达到这些值。
IntroductionThe likelihood of survival from ventricular fibrillation (VF) declines 7%-10% per minute until successful defibrillation. When VF duration is prolonged, immediate defibrillation of the ischemic myocardium is less likely to result in ROSC, and repeated unsuccessful defibrillations are associated with post-resuscitation myocardial dysfunction. Thus, the timing of defibrillation should be based upon the probability of shock success-a function of VF duration. Unfortunately, VF duration is often unknown in out-of-hospital cardiac arrest (OHCA) and a better predictor of shock success is needed.ObjectiveTo assess the ability of end-tidal carbon dioxide (EtCO2) to predict successful defibrillation in OHCA.MethodsThis retrospective study included adult patients among four EMS systems who experienced non-traumatic OHCA from August, 2015-July, 2017 and received one or more defibrillations. First and succedent shocks were analyzed separately. First shocks represented EMS-attempted defibrillation of patients who had not received a prior AED shock, whereas succedent shocks included all shocks subsequent to the first. Logistic regression provided odds ratios (OR) for first shocks resulting in ROSC, while a generalized estimating equation was used to analyze succedent shocks.ResultsAmong 324 patients, 869 shocks were delivered by EMS (153 first and 716 succedent shocks). Layperson CPR was performed in 48.1% of cases and 21.6% received an AED shock before EMS arrival. First defibrillation ROSC was more likely with layperson CPR (OR = 4.41;p = 0.01) and increasing EtCO2 (OR = 1.03/mmHg;p = 0.01). No other variables were statistically significant. Notably, only one patient with EtCO2 < 20 mmHg was successfully defibrillated on the first shock. The probability of ROSC was higher with increasing values of EtCO2 when layperson CPR was provided, yet remained relatively unchanged across all values of EtCO2 >= 20 mmHg without layperson CPR. The optimal threshold first shock EtCO2 was 27 and 32 mmHg for those with/without layperson CPR, respectively. EtCO2 was not a predictor of ROSC for succedent shocks.ConclusionsAn optimal defibrillation threshold EtCO2 of 27 and 32 mmHg was observed for patients with and without layperson CPR, respectively. Further studies are warranted to verify these results and to evaluate the clinical effect of delaying defibrillation in favor of chest compressions until these values are attained.