Heart rate and heart rate variability as a prognosticating feature for functional outcome after cardiac arrest: A scoping review.
Heart rate and heart rate variability as a prognosticating feature for functional outcome after cardiac arrest: A scoping review.
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DOI：
10.1016/j.resplu.2023.100450
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发表时间：
2023-09
影响因子：
2.4
通讯作者：
Park, Soojin
中科院分区：
文献类型：
--
作者：
Kwon, Soon Bin;Megjhani, Murad;Nametz, Daniel;Agarwal, Sachin;Park, Soojin
尽管心肺复苏和心脏骤停后护理方面取得了重大进展，但院外心脏骤停患者的良好结局仍然很低。这些患者死亡的主要原因之一是停止维持生命的治疗。需要精确且公平的预测工具来支持家庭避免过早或不适当的 WLST。心率 (HR) 和心率变异性 (HRV) 因其与结果的相关性而闻名，并且被定位为有用的预测方式。本次范围审查的目的是严格探索哪些心电图特征已被证明可以预测心脏骤停后患者的功能结果。该检索在 Pubmed、EMBASE 和 SCOPUS 中检索了 2011 年 1 月 1 日至 2022 年 9 月 29 日发表的研究，包括英语或韩语论文。纳入 7 项研究，总共 1359 名患者。四项研究评估了 HR，一项研究评估了 RR 反转，两项研究评估了 HRV。所有研究均为回顾性研究，其中 3 项为多中心研究，4 项为单中心研究。所有七项研究均纳入了心脏骤停后接受目标温度管理 (TTM) 的患者，两项研究纳入了未进行 TTM 的患者。五项研究使用大脑性能类别来评估功能结果，两项研究使用格拉斯哥结果评分，一项研究使用改良的兰金量表。三项研究测量了出院时的结果，一项研究测量了自主循环恢复后 14 天的结果，两项研究测量了 3 个月后的结果，一项研究测量了 1 年后的结果。在所有评估心率的研究中，较低的心率与良好的功能结果相关。两项研究发现 HRV 的复杂性越高，与良好的功能结果相关。 HR 和 HRV 显示与 CA 后患者的功能结果存在明显关联，但其预测的临床效用尚不确定。
Despite significant progress in cardiopulmonary resuscitation and post-cardiac arrest care, favorable outcome in out-of hospital sudden cardiac arrest patients remains low. One of the main reasons for mortality in these patients is withdrawal of life-sustaining treatment. There is a need for precise and equitable prognostication tools to support families in avoiding premature or inappropriate WLST. Heart rate (HR) and heart rate variability (HRV) have been noted for their association with outcome, and are positioned to be a useful modality for prognostication. The aim of this scoping review is to rigorously explore which electrocardiography features have been shown to predict functional outcome in post-cardiac arrest patients. The search was performed in Pubmed, EMBASE, and SCOPUS for studies published from January 1, 2011, to September 29, 2022, including papers in English or Korean. Seven studies were included with a total of 1359 patients. Four studies evaluated HR, one study evaluated RR inverval, and two studies evaluated HRV. All studies were retrospective, with 3 multi-center and 4 single-center studies. All seven studies were inclusive of patients who underwent targeted temperature management (TTM) after cardiac arrest, and two studies included patients without TTM. Five studies used cerebral performance category to assess functional outcome, two studies used Glasgow outcome score, and one study used modified Rankin scale. Three studies measured outcome at hospital discharge, one study measured outcome at 14 days after return of spontaneous circulation, two studies measured outcome after 3 months, and one after 1 year. In all studies that evaluated HR, lower HR was associated with favorable functional outcome. Two studies found that higher complexity of HRV was associated with favorable functional outcome. HR and HRV showed clear associations with functional outcome in patients after CA, but cinilcial utility for prognostication is uncertain.
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