| BackgroundCardiac arrest is still one of the main causes of adult mortality worldwide,and multiple factors are related to the clinical prognosis of patients.However,the impact of the application of echocardiography on the prognosis of cardiac arrest patients is still lacking sufficient research.In addition,transesophageal echocardiography(TEE)can continuously monitor the cardiopulmonary resuscitation process without external interference.Relevant researches have been accumulated abroad,but currently there is no research on the application of TEE in the emergency field of China to evaluate patients with cardiac arrest.ObjectivesThe aims of the study include to explore the clinical factors that affect the prognosis of hospitalized cardiac arrest patients in the Intensive Care Unit(ICU),and the relationship between the use of echocardiography technology and the prognosis of cardiac arrest patients.Also,we aim to explore the application value of TEE in emergency environment for cardiac arrest patients,and the feasibility of its application.MethodsThe first part of this study is a retrospective study.The study included adult patients aged 18 and above who had a discharge diagnosis including cardiac arrest and had hospitalization in ICU from the database of the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ)in the United States.Firstly,this article conducted a univariate analysis of potential prognostic factors for cardiac arrest patients between the hospital survival group and the non-survival group.Subsequently,a stepwise fitting multivariate logistic regression analysis was used to explore independent risk factors related to hospital death,and a predictive model was constructed based on the regression results.Secondly,this study grouped patients based on whether they had undergone echocardiography and evaluated the correlation between the application of echocardiography.The prognosis of patients with cardiac arrest are estimated using various models,including propensity score matching methods for whether the patients received echocardiography.The second part of this study is a single center,forward-looking,exploratory observational study.The study included patients aged 18 and above with non-traumatic cardiac arrest.TEE was used to evaluate the patient’s condition during and after resuscitation,focusing on the blood flow mechanism under different compression methods,cardiac activity,etiology of cardiac arrest,compression site,and early myocardial dysfunction after resuscitation.ResultsPart I:A total of 1772 patients diagnosed with cardiac arrest were included in the study.The median age of the patients in the sample was 66 years old,with 705 female patients(39.8%).Among these patients,a total of 963(54.3%)experienced hospital deaths.Stepwise fitting multivariate logistic regression analysis showed that the etiology diagnosis of cardiac arrest,age adjusted Charlson Comorbidity Index(CCI)score,Body Mass Index(BMI),vital signs within 24 hours of admission to the ICU,lowest lactate level within 24 hours of admission to the ICU,Glasgow Coma Scale(GCS),use of echocardiography,use of invasive mechanical ventilation and the use of vasopressin are the main factors related to hospital mortality in patients with cardiac arrest.Based on the results of multivariate logistic regression,the area under the receiver operating characteristic curve(ROC)of the constructed prediction model is 0.807(95%CI:0.7870.826).Multiple model results have shown that the use of echocardiography can reduce hospital mortality and 28-day mortality after admission to the ICU.Part II:The study ultimately included 29 patients with cardiac arrest for analysis,including 25 patients during resuscitation and 9 patients after resuscitation.Among the patients who underwent TEE evaluation during resuscitation,12 were in-hospital cardiac arrest(IHCA)patients,and 5 patients achieved spontaneous circulation recovery(ROSC).While no patients with out-of-hosptial cardiac arrest(OHCA)received ROSC.The evaluation of TEE during resuscitation revealed that the patient’s mitral valve exhibited three states during the compression phase of chest compressions(closed,alternating closed or open,and open),independent of the compression method.The open state of the mitral valve during the compression phase was associated with a low ROSC rate.Among patients who were traditionally diagnosed with asystole or pulseless electrical activity.54.2%had cardiac activity under ultrasound.The presence of cardiac activity under ultrasound was associated with a higher ROSC rate.In terms of etiology.11 patients(44%)found abnormalities on ultrasound examination,including mitral valve prolapse.right heart dilation,left heart dilation,and right heart thrombus.Among them.4 cases were related to underlying diseases,and 2 patients were suspected of pulmonary embolism with TEE.In terms of position of compression,TEE found that 81.8%of patients’ main compression sites were located in the left ventricular outflow tract or aortic root,and 63.6%of patients observed that the left Ventricular outflow tract or aortic root was completely blocked during compression.After resuscitation,79.8%of patients experienced early myocardial dysfunction,with 71.4%of patients dying within 3 days.No complications related to TEE were found in the study.ConclusionMultiple factors are associated with the prognosis of cardiac arrest patients treated in the ICU,among which echocardiography can reduce the hospital mortality rate and 28-day mortality rate of cardiac arrest patients.TEE can help evaluate cardiac activity,etiology,compression position,resuscitation blood flow mechanism during cardiopulmonary resuscitation,and myocardial dysfunction after resuscitation in patients with cardiac arrest.The application of this technology in emergency environments is feasible and safe for evaluating patients with cardiac arrest. |
PDF Full Text Request