背景:在心肺复苏(CPR)期间,一些参数(例如,动脉内压测量和呼气末二氧化碳(EtCO2)指示复苏的质量和结果.这些参数通常基于监测血液动力学状态。灌注指数(PI)是根据光电体积描记术(PPG)信号的计算,并且显示PPG信号中的脉动与非脉动光吸收或反射的比例。它有助于在危重患者的护理中评估心输出量和组织灌注。它最重要的优点是,它可以很容易地测量与脉搏血氧计探头连接到手指(非侵入性),可以客观地重复,可以快速应用,而且便宜。正常PI值范围从0.2%到20%。尽管被认为是血液动力学的一个有价值的指标,关于其在心脏骤停患者中的相关性的信息有限.尽管已知PI是指示血液动力学的有价值的参数,关于其在心脏骤停患者中的价值的信息是有限的。这项研究旨在评估PI和EtCO2在预测心脏骤停患者自发循环(ROSC)恢复方面的表现。
方法:这是一个单中心,prospective,观察性临床研究,包括院外和院内成人心脏骤停患者。该研究于2018年11月1日至2019年4月30日在Hacettepe大学医院急诊科(ED)进行,安卡拉,土耳其。在插管时(t0)和每五分钟(t5,t10,t15)记录患者的EtCO2值。..)在CPR期间。随着这些测量,PI值是用Masimo信号提取技术装置(Masimo,加州,美国)。该研究的主要结果是PI在预测心脏骤停患者ROSC方面的表现。该研究的次要结果是EtCO2在预测心脏骤停患者的ROSC方面的表现以及PI和EtCO2值之间的关联。
结果:我们共纳入100例。患者平均年龄为70.4±13.4岁,65%是男性。29例患者实现了ROSC。在任何分钟,ROSC(+)和ROSC(-)组之间的PI值没有统计学差异。然而,在ROSC(+)组中,从第5分钟开始观察到EtCO2值很高(分别为t5,p=0.010;t10,p<0.001;t15,p=0.014;t20,p=0.033;t25,p=0.003)。在0、5、10、15、20和25分钟时,PI和EtCO2值之间没有相关性(t0,p=0.436;t5,p=0.154;t10,p=0.557;t15,p=0.740;t20,p=0.241;t25,p=0.201)。
结论:在心脏骤停患者插管复苏期间测量PI值并不能帮助临床医生预测结果。此外,未发现与EtCO2值相关.然而,从第五分钟开始,ROSC患者的EtCO2值仍然很高。关于心脏骤停患者PI的最佳使用,还需要进一步的大规模研究。
BACKGROUND: During cardiopulmonary resuscitation (CPR), some parameters (e.g., intraarterial pressure measurement and end-tidal carbon dioxide (EtCO2)) indicate the quality and outcome of resuscitation. These parameters are generally based on monitoring the hemodynamic status. Perfusion index (PI) is a calculation from the photoplethysmography (PPG) signal and displays the proportion of pulsatile to non-pulsatile light absorption or reflection in the PPG signal. It helps to evaluate cardiac output and tissue perfusion in the care of a critical patient. Its most important advantages are that it can be easily measured with a pulse oximeter probe attached to the finger (non-invasive), can be objectively repeated, can be applied quickly, and is inexpensive. Normal PI values range from 0.2% to 20%. Despite being recognized as a valuable indicator of hemodynamics, there is limited information regarding its relevance in patients experiencing cardiac arrest. Although the PI is known to be a valuable parameter to indicate hemodynamics, information about its value in cardiac arrest patients is limited. This study aims to evaluate the performance of PI and EtCO2 in predicting the return of spontaneous circulation (ROSC) among cardiac arrest patients.
METHODS: This was a single-center, prospective, observational clinical study including both out-of-hospital and in-hospital adult cardiac arrest patients. The study was conducted from November 1, 2018 to April 30, 2019 at the Emergency Department (ED) of the Hacettepe University Hospital, Ankara, Turkey. The EtCO2 values of the patients were recorded at the time they were intubated (t0) and every five minutes (t5, t10, t15...) during CPR. Along with these measurements, PI values were measured with the Masimo Signal Extraction Technology device (Masimo, California, United States). The study\'s primary outcome was PI\'s performance in predicting the ROSC among cardiac arrest patients. The secondary outcomes of the study were the performance of EtCO2 in predicting the ROSC among cardiac arrest patients and the association between PI and EtCO2 values.
RESULTS: We included a total of 100 cases. The mean age of patients was 70.4 ± 13.4 years, and 65% were male. The ROSC was achieved in 29 patients. There was no statistical difference in PI values between the ROSC (+) and ROSC (-) groups at any minute. However, in the ROSC (+) group, EtCO2 values were observed to be high starting from the fifth minute (t5, p=0.010; t10, p<0.001; t15, p=0.014; t20, p=0.033; t25, p=0.003, respectively). There was no correlation between the PI and EtCO2 values at 0, 5, 10, 15, 20, and 25 minutes (t0, p=0.436; t5, p=0.154; t10, p=0.557; t15, p=0.740; t20 p=0.241; t25 p=0.201, respectively).
CONCLUSIONS: Measuring PI values during resuscitation in intubated cardiac arrest patients does not help clinicians predict the outcome. In addition, no correlation was found with EtCO2 values. However, EtCO2 values remained high in patients with the ROSC from the fifth minute onward. Further larger-scale studies are needed regarding the optimal use of PI in cardiac arrest patients.