Incidence and Clinical Relevance of Echocardiographic Visualization of Occult Ventricular Fibrillation: A Multicenter Prospective Study of Patients Presenting to the Emergency Department After Out-of-Hospital Cardiac Arrest.

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine Pub Date : 2025-06-30 DOI:10.1016/j.annemergmed.2025.04.014

Romolo Gaspari,Robert Lindsay,Trent She,Josie Acuna,Andrew Balk,Jakub Bartnik,Jacob Baxter,Drew Clare,Richard J Caplan,John DeAngelis,Levi Filler,Powell Graham,Mike Hill,John Hipskind,Ryan Joseph,Monica Kapoor,Tobi Kummer,Margaret Lewis,Stephanie Midgley,Ari Nalbandian,Offdan Narveas-Guerra,Jason Nomura,Irina Sanjeevan,Mark Scheatzle,Nikolai Schnittke,Michael Secko,Zachary Soucy,Jeffrey R Stowell,Rebecca G Theophanous,Jordan Tozer,Tyler Yates,Timothy Gleeson

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引用次数: 0

Abstract

STUDY OBJECTIVES Ventricular fibrillation (VF) is traditionally identified on ECG but echocardiography can visualize myocardial fibrillation. The prevalence and importance of occult VF defined as a nonshockable ECG rhythm but VF by echocardiography is unknown. METHODS In this multicenter, prospective study, emergency department patients presenting following out-of-hospital cardiac arrest were eligible for inclusion if echocardiography and ECG were performed simultaneously. Recorded echocardiography and ECG were interpreted separately by physicians blinded to all patient and resuscitation information. The primary outcome was percentage of occult VF. The secondary outcomes included survival to hospital discharge, termination of defibrillated VF, and return of spontaneous circulation (ROSC). Termination of VF is described as a postdefibrillation change in ECG rhythm to a nonshockable rhythm. Multivariate modeling accounted for confounding variables. RESULTS Of 811 patients enrolled, 5.3% (95% confidence interval [CI] 3.9 to 7.1) demonstrated occult VF. An additional 24.9% (95% CI 22.1 to 28.0) demonstrated ECG VF. Of the patients with occult VF, 81.4% demonstrated ECG pulseless electrical activity (PEA) and 18.6% demonstrated ECG asystole. Occult VF was less likely to be defibrillated compared with ECG VF. Defibrillation was not significantly more likely to terminate occult VF (75.0% vs 55.6%; odds ratio [OR], 2.3; 95% CI 0.42 to 15.24). ROSC was not statistically different for occult VF compared with ECG VF (39.5% vs 24.8%; OR, 2.26; 95% CI 0.87 to 5.9). Survival to hospital discharge was no different for patients with occult VF compared with ECG VF (7.0% vs 5.4%; OR, 3.6; 95% CI 0.63 to 19.2) despite fewer defibrillation attempts for patients with occult VF. CONCLUSION Occult VF was seen in 5.3% of patients following out-of-hospital cardiac arrest. Recognizing and treating occult VF who otherwise would have been treated as PEA or asystole led to survival outcomes indistinguishable to traditionally recognized VF.

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隐匿性心室颤动的超声心动图显示的发生率和临床相关性：院外心脏骤停后急诊患者的多中心前瞻性研究

研究目的心室颤动（VF）传统上是通过心电图诊断的，但超声心动图可以显示心肌颤动。隐匿性室性心动过速定义为非震荡性心电节律，但超声心动图显示的室性心动过速的患病率和重要性尚不清楚。方法在这项多中心前瞻性研究中，如果同时进行超声心动图和心电图检查，急诊科出现院外心脏骤停的患者符合纳入标准。记录的超声心动图和心电图分别由不了解所有患者和复苏信息的医生进行解释。主要转归是隐匿性室性肺水肿的百分比。次要结局包括存活至出院、去纤颤室颤终止和自然循环恢复（ROSC）。心室颤动终止被描述为除颤后心电图节律转变为非震荡节律。多变量建模解释了混杂变量。结果入组的811例患者中，5.3%（95%可信区间[CI] 3.9 ~ 7.1）表现为隐匿性VF。另有24.9% （95% CI 22.1 ~ 28.0）表现为心电图虚颤。隐匿性VF患者中，81.4%表现为心电图无脉性电活动（PEA）， 18.6%表现为心电图骤停。隐匿性室颤比ECG室颤更不容易除颤。除颤终止隐匿性室性房颤的可能性不明显增加(75.0% vs 55.6%；优势比[OR]， 2.3；95% CI 0.42 ~ 15.24)。隐匿性VF与ECG VF的ROSC无统计学差异(39.5% vs 24.8%；或者,2.26;95% CI 0.87 ~ 5.9)。隐匿性VF患者与ECG VF患者的出院生存率无差异(7.0% vs 5.4%；或者,3.6;95% CI 0.63 - 19.2)，尽管隐匿性室颤患者的除颤次数较少。结论院外心脏骤停患者隐匿性室颤发生率为5.3%。识别和治疗隐匿性室性心动过速，否则将被视为PEA或骤停，导致生存结果与传统识别的室性心动过速难以区分。

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来源期刊

Annals of emergency medicine 医学-急救医学

CiteScore

8.30

自引率

4.80%

发文量

819

审稿时长

20 days

期刊介绍： Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics.