Electrical and mechanical recovery of cardiac function following out-of-hospital cardiac arrest
| Autor: | Criss Brainard, Rebecca Sell, Edward M. Castillo, James V. Dunford, Brenna Lawrence, Roger Fisher, Nathan Wilkes, Renee Sarno, Daniel P. Davis, Ruchika D Husa |
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| Rok vydání: | 2012 |
| Předmět: |
Cardiac function curve
Male medicine.medical_specialty medicine.medical_treatment Emergency Nursing Return of spontaneous circulation Sensitivity and Specificity California Predictive Value of Tests Internal medicine Heart rate Medicine Humans Derivation Cardiopulmonary resuscitation Prospective Studies Aged Capnography medicine.diagnostic_test business.industry Guideline Recovery of Function Middle Aged Cardiopulmonary Resuscitation Surgery Treatment Outcome ROC Curve Predictive value of tests Area Under Curve Emergency Medicine Cardiology Female Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 84(1) |
| ISSN: | 1873-1570 |
| Popis: | Background Compression pauses may be particularly harmful following the electrical recovery but prior to the mechanical recovery from cardiopulmonary arrest. Methods and results A convenience sample of patients with out-of-hospital cardiac arrest (OOHCA) were identified. Data were exported from defibrillators to define compression pauses, electrocardiogram rhythm, PetCO2, and the presence of palpable pulses. Pulse-check episodes were randomly assigned to a derivation set (one-third) and a validation set (two-thirds). Both an unweighted and a weighted receiver–operator curve (ROC) analysis were performed on the derivation set to identify optimal thresholds to predict ROSC using heart rate and PetCO2. A sequential decision guideline was generated to predict the presence of ROSC during compressions and confirm perfusion once compressions were stopped. The ability of this decision guideline to correctly identify pauses in which pulses were and were not palpated was then evaluated. A total of 145 patients with 349 compression pauses were included. The ROC analyses on the derivation set identified an optimal pre-pause heart rate threshold of >40beatsmin −1 and an optimal PetCO2 threshold of >20mmHg to predict ROSC. A sequential decision guideline was developed using pre-pause heart rate and PetCO2 as well as the PetCO2 pattern during compression pauses to predict and rapidly confirm ROSC. This decision guideline demonstrated excellent predictive ability to identifying compression pauses with and without palpable pulses (positive predictive value 95%, negative predictive value 99%). The mean latency period between recovery of electrical and mechanical cardiac function was 78s (95% CI 36–120s). Conclusions Heart rate and PetCO2 can predict ROSC without stopping compressions, and the PetCO2 pattern during compression pauses can rapidly confirm ROSC. Use of a sequential decision guideline using heart rate and PetCO2 may reduce unnecessary compression pauses during critical moments during recovery from cardiopulmonary arrest. |
| Databáze: | OpenAIRE |
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