Occult Ventricular Fibrillation Visualized by Echocardiogram During Cardiac Arrest: A Retrospective Observational Study From the Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON).

IF 1.6 Q2 EMERGENCY MEDICINE
Romolo Gaspari, Srikar Adhikari, Timothy Gleeson, Monica Kapoor, Robert Lindsay, Vicki Noble, Jason T Nomura, Anthony Weekes, Dan Theodoro
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引用次数: 0

Abstract

Objectives: Cardiac arrest patients with a shockable rhythm are more likely to survive an out-of-hospital cardiac arrest (OHCA) compared with a nonshockable rhythm. An electrocardiogram (ECG) is the most common way to identify a shockable rhythm, but it can miss patients with clinically significant ventricular fibrillation (vfib). We sought to determine the percentage of nonshockable OHCA patients that demonstrated vfib on echo.

Methods: Secondary analysis of echo images recorded from a prior study from our group, Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON), a multicenter, observational study of OHCA patients presenting to the emergency department with nonshockable rhythms. Using ECG and echocardiogram images recorded during the initial cardiopulmonary resuscitation (CPR) pause, 2 independent emergency physicians determined the presence of vfib. Two experienced emergency physicians (R.G. and T.G.) reviewed echo images with adjudication by a third if necessary. ECG interpretation was unblinded to patient information. The primary outcome was the proportion of patients in occult vfib.

Results: During the first CPR pause, reviewers noted occult vfib in 22/685 (3.2%; 95% CI, 2.1%-4.8%) subjects. Patients with ECG vfib (n = 55) were defibrillated immediately during the first pause in CPR, but no patients with occult vfib during the first pause in CPR were defibrillated. Subsequently, 50% (11 of 22) of occult vfib patients were defibrillated when ECG vfib was recognized during an ensuing pause in CPR.

Conclusion: One in 33 OHCAs with a nonshockable ECG rhythm exhibits VF on echocardiogram. Patients presenting to the emergency department in a presumed nonshockable rhythm following OHCA may benefit from prompt defibrillation if personnel recognize occult vfib on echo.

心脏骤停时超声心动图显示的隐匿性心室颤动:一项来自超声结果网络(REASON)实时评估和评估的回顾性观察研究。
目的:与非震荡性心律相比,伴有震荡性心律的心脏骤停患者更有可能在院外心脏骤停(OHCA)中存活。心电图(ECG)是识别震荡性心律最常见的方法,但它可能会错过临床显著的心室颤动(vfib)患者。我们试图确定非震荡性OHCA患者超声显示vfib的百分比。方法:对我们组之前的一项研究记录的回声图像进行二次分析,超声结果网络实时评估和评估(REASON),这是一项多中心观察性研究,研究对象是就诊于急诊科的非震荡性心律OHCA患者。利用在最初心肺复苏(CPR)暂停期间记录的心电图和超声心动图图像,2名独立的急诊医生确定了vfib的存在。两位经验丰富的急诊医生(R.G.和T.G.)检查了回声图像,如有必要,由第三位医生裁决。心电图解释不受患者信息的影响。主要结局是隐匿性室性纤颤患者的比例。结果:在第一次心肺复苏术暂停期间,审稿人发现22/685例隐匿性室颤(3.2%;95% CI, 2.1%-4.8%)受试者。心电图虚颤患者(n = 55)在CPR第一次暂停期间立即进行除颤,但在CPR第一次暂停期间没有隐匿性虚颤患者进行除颤。随后,50%(22例中的11例)隐蔽性室性纤颤患者在随后的心肺复苏术暂停期间识别出ECG vfib后进行了除颤。结论:超声心动图显示1 / 33的非震荡性心律ohca表现为VF。如果工作人员通过回声识别出隐匿性室颤,在OHCA后以假定的非震荡性心律就诊的患者可能会受益于及时除颤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
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0.00%
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审稿时长
5 weeks
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