聚焦经胸超声心动图位置对心脏骤停时心脏显像的成功率：视频回顾分析

IF 2.1 Q3 CRITICAL CARE MEDICINE Resuscitation plus Pub Date : 2024-09-21 DOI:10.1016/j.resplu.2024.100774

Daniel M. Rolston, Ghania Haddad, Nicole Sales, Daniel Jafari, Margaret Gorlin, Robert Ellspermann, Mathew Nelson, Timmy Li, Allison Cohen

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引用次数: 0

摘要

目的我们的主要目的是确定在心脏骤停患者胸外按压中断期间，聚焦经胸超声心动图（TTE）位置（剑突下、胸骨旁或心尖）对心脏显像的成功率是否存在差异。其次，我们试图确定胸外按压中断时间与聚焦 TTE 位置是否存在差异。方法我们对 2018 年 11 月至 2023 年 11 月期间在一家四级护理急诊科进行的成人心脏骤停复苏录像进行了回顾性队列研究。如果 1) 在视频审查中看到心脏显像，或 2) 在记录中讨论了心脏显像，则聚焦 TTE 成功。采用卡方检验评估成功率的差异，采用方差分析评估基于 TTE 位置的中断时间差异。研究建立了重复测量多变量回归模型，以控制主要和次要目标的临床相关变量。成功率无差异：剑突下 83.4%、胸骨旁 88.1%、心尖 95.7%（P=0.190），多变量回归分析也无差异（P=0.189）。每个部位的平均胸外按压中断时间没有差异：剑突下 15 秒（IQR 12-23 秒），胸骨旁 17 秒（IQR 11-22 秒），心尖 19 秒（IQR 15-25 秒，p = 0.446），多变量逻辑回归分析中也没有差异（p = 0.803）。结论在心脏骤停中，胸骨旁和心尖 TTE 位置的心脏显像成功率相似，压迫中断时间与更常用的剑突下位置相似。

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Success of focused transthoracic echocardiography locations for cardiac visualization during cardiac arrest: A video-review analysis

Objective

Our primary objective was to determine if there was a difference in success of cardiac visualization by focused transthoracic echocardiography (TTE) location (subxiphoid, parasternal, or apical) during chest compression interruptions among cardiac arrest patients. Secondarily, we sought to determine whether there were differences in chest compression interruption times with the focused TTE locations.

Methods

We conducted a retrospective cohort study of video-recorded, adult, cardiac arrest resuscitations in a quaternary care Emergency Department from 11/2018 to 11/2023. Focused TTE was successful if 1) cardiac visualization was seen on video review, or 2) cardiac visualization was discussed in the recording. A chi-squared test was used to assess differences in success and ANOVA was used to assess differences in interruption times based on TTE locations. Repeated measures multivariable regression models were constructed to control for clinically relevant variables for the primary and secondary objectives.

Results

136 patients and 365 focused TTE attempts were included in the study (241 subxiphoid, 101 parasternal, and 23 apical). There was no difference in the success rate: subxiphoid 83.4%, parasternal 88.1%, and apical 95.7% (p = 0.190) or in multivariable regression analysis (p = 0.189). There was no difference in the mean chest compression interruption time for each site: subxiphoid 15 sec. (IQR 12–23 sec.), parasternal 17 sec. (IQR 11–22 sec.), and apical 19 sec. (IQR 15–25 sec., p = 0.446) or in multivariable logistic regression analysis (p = 0.803). Sonographers with ≥ 50 quality assured focused TTEs had higher success than those without (94.4% vs. 75.1%; p < 0.001).

Conclusions

In cardiac arrest, the parasternal and apical TTE locations had similar success of cardiac visualization and similar compression interruption times to the more commonly used subxiphoid location.

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