Impact of Hepatic Portal Venous Gas on the Prognosis of Traumatic Out-of-Hospital Cardiac Arrest: A Reason to Consider Terminating Cardiopulmonary Resuscitation.

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Emergency Medicine International Pub Date : 2024-08-12 eCollection Date: 2024-01-01 DOI:10.1155/2024/7756946
Seok Ran Yeom, Mun Ki Min, Dae Sup Lee, Min Jee Lee, Mo Se Chun, Sung Wook Park, Wook Tae Yang
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引用次数: 0

Abstract

Background: We evaluated the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) by assessing the presence of hepatic portal vein gas (HPVG) observed in ultrasound (US) or point-of-care ultrasonography (POCUS) performed during CPR. Furthermore, we aimed to understand the role of HPVG in decision-making regarding CPR discontinuation or withholding in traumatic OHCA.

Methods: The retrospective study was conducted at the level 1 trauma center of urban academic medical centers in South Korea. We included adult trauma OHCA patients who underwent CPR between January 1, 2020, and June 30, 2022. Data on traumatic OHCA patients who presented to the level I trauma center during this period were extracted from the hospital's electronic medical record system. The arrest data were separately managed through the hospital's electronic medical record system for quality control, specifically the arrest registry. US images or clips of the hepatic portal vasculature (HPV) during CPR were used to assess the presence of HPVG. These images were independently reviewed by two emergency medicine physicians with several years of US examination experience who were blinded to all clinical details and outcomes. We evaluated the prognosis of traumatic OHCA by assessing the presence of HPVG using the US. In addition, we analyzed the general characteristics and assessed the impact on the ROSC in traumatic OHCA.

Results: Among the 383 cardiac arrest patients, 318 traumatic OHCA patients were included. The mean age was 54.9 ± 19.4 years, and most patients were male. The initial rhythm was mainly asystole, and falls were the most frequent cause of injury. The overall ROSC rate was 18.8%, with a survival rate of 7.2% at hospital discharge. Among the 50 patients who underwent a US examination of HPV, 40 showed HPVG. The HPVG group had a significantly lower ROSC rate and survival rate at ED discharge and hospital discharge compared to the group without HPVG.

Conclusion: Traumatic OHCA with HPVG presents a significantly worse prognosis. This suggests that early consideration of termination or withholding of CPR may be appropriate in such cases.

肝门静脉气体对创伤性院外心脏骤停预后的影响:考虑终止心肺复苏的理由。
背景:我们通过评估在心肺复苏期间进行的超声(US)或护理点超声造影(POCUS)中观察到的肝门静脉气体(HPVG)的存在情况来评估创伤性院外心脏骤停(OHCA)的预后。此外,我们还旨在了解 HPVG 在创伤性 OHCA 患者终止或暂停心肺复苏决策中的作用:这项回顾性研究在韩国城市学术医疗中心的一级创伤中心进行。我们纳入了 2020 年 1 月 1 日至 2022 年 6 月 30 日期间接受心肺复苏的创伤性 OHCA 成人患者。在此期间前往一级创伤中心就诊的创伤性 OHCA 患者的数据来自医院的电子病历系统。心跳骤停数据由医院的电子病历系统单独管理,以进行质量控制,特别是心跳骤停登记。心肺复苏期间肝门血管(HPV)的 US 图像或剪辑用于评估 HPVG 的存在。这些图像由两名具有多年 US 检查经验的急诊科医生独立审核,他们对所有临床细节和结果都是盲法。我们通过使用 US 评估是否存在 HPVG 来评估创伤性 OHCA 的预后。此外,我们还分析了创伤性 OHCA 患者的一般特征,并评估了其对 ROSC 的影响:结果:在 383 名心脏骤停患者中,有 318 名创伤性 OHCA 患者。平均年龄为(54.9±19.4)岁,大多数患者为男性。初始心律主要是心跳骤停,跌倒是最常见的受伤原因。总体ROSC率为18.8%,出院时存活率为7.2%。在 50 名接受 HPV US 检查的患者中,有 40 人显示为 HPVG。与无HPVG组相比,HPVG组的ROSC率和出院时的存活率明显较低:结论:伴有 HPVG 的创伤性 OHCA 预后明显较差。结论:伴有 HPVG 的创伤性 OHCA 预后明显较差,这表明在此类病例中应及早考虑终止或暂停心肺复苏。
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来源期刊
Emergency Medicine International
Emergency Medicine International EMERGENCY MEDICINE-
CiteScore
0.10
自引率
0.00%
发文量
187
审稿时长
17 weeks
期刊介绍: Emergency Medicine International is a peer-reviewed, Open Access journal that provides a forum for doctors, nurses, paramedics and ambulance staff. The journal publishes original research articles, review articles, and clinical studies related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.
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