Effectiveness of near-infrared spectroscopy-guided continuous chest compression resuscitation without rhythm check in patients with out-of-hospital cardiac arrest: The prospective multicenter TripleCPR 16 study,Resuscitation

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Effectiveness of near-infrared spectroscopy-guided continuous chest compression resuscitation without rhythm check in patients with out-of-hospital cardiac arrest: The prospective multicenter TripleCPR 16 study
Resuscitation ( IF 6.5 ) Pub Date : 2021-09-16 , DOI: 10.1016/j.resuscitation.2021.09.006
Ryosuke Takegawa ₁ , Satsuki Taniuchi ₂ , Mitsuo Ohnishi ₃ , Takashi Muroya ₄ , Koichi Hayakawa ₅ , Jotaro Tachino ₆ , Tomoya Hirose ₆ , Shunichiro Nakao ₆ , Arisa Muratsu ₆ , Tomohiko Sakai ₆ , Kei Hayashida ₇ , Ayumi Shintani ₂ , Lance B Becker ₇ , Takeshi Shimazu ₆ , Tadahiko Shiozaki ₆

Affiliation

Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan; Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA; Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA.
Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka City, Osaka 545-0051, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan; Department of Acute Medicine and Critical Care Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, Osaka 540-0006, Japan.
Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Humizono-cho, Moriguchi, Osaka 570-8507, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA; Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA.

Background

The proportion of adult patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) remains unchanged since 2012. A better resuscitation strategy is needed. This study evaluated the effectiveness of a regional cerebral oxygen saturation (rSO₂)-guided resuscitation protocol without rhythm check based on our previous study.

Methods

Because defibrillation is the definitive therapy that should be performed without delay for shockable rhythm, the study subjects were OHCA patients with non-shockable rhythm on hospital arrival at three emergency departments. They were divided into three groups based on their baseline rSO₂ value (%): ≥50, ≥40 to <50, or <40. Continuous chest compression without rhythm checks was performed for 16 minutes or until a maximum increase in rSO₂ of 10%, 20%, or 35% was achieved in each group, respectively. This intervention cohort was compared with a historical control cohort regarding the probability of ROSC using inverse probability of treatment weighting (IPTW) with propensity score.

Results

The control and intervention cohorts respectively included 86 and 225 patients. The rate of ROSC was not significantly different between the groups (adjusted OR 0.91 [95% CI, 0.64–1.29], P=0.60), but no serious adverse events occurred. Sensitivity analyses 1 and 2 showed a significant difference or positive tendency for higher probability of ROSC (adjusted OR 1.63 [95% CI, 1.22–2.17], P<0.001) (adjusted OR 1.25 [95% CI, 0.95–1.63], P=0.11).

Conclusions

This trial suggested that a new cardiopulmonary resuscitation protocol with different rhythm check timing could be created using the rSO₂ value.

Clinical trial number: UMIN000025684

中文翻译：

近红外光谱引导连续胸外按压复苏术对院外心脏骤停患者进行无节律检查的有效性：前瞻性多中心 TripleCPR 16 研究

背景

自 2012 年以来，院外心脏骤停 (OHCA) 后自主循环恢复 (ROSC) 的成年患者比例保持不变。需要更好的复苏策略。本研究根据我们之前的研究评估了不进行节律检查的局部脑氧饱和度 (rSO ₂ ) 指导的复苏方案的有效性。

方法

由于除颤是应对可电击心律立即进行的最终治疗，因此研究对象是到达三个急诊科时具有不可电击心律的 OHCA 患者。他们根据其基线 rSO ₂值 (%)分为三组：≥50、≥40 至 <50 或 <40。在没有节律检查的情况下进行连续胸外按压 16 分钟，或直到每组的rSO _{2 分别}最大增加10%、20% 或 35%。将该干预队列与历史对照队列进行比较，使用治疗加权的逆概率 (IPTW) 和倾向评分来确定 ROSC 的概率。

结果

对照组和干预组分别包括 86 和 225 名患者。组间 ROSC 率无显着差异（调整后 OR 0.91 [95% CI, 0.64–1.29]，P=0.60），但未发生严重不良事件。敏感性分析 1 和 2 显示出较高的 ROSC 概率的显着差异或阳性趋势（调整后的 OR 1.63 [95% CI，1.22-2.17]，P<0.001）（调整后的 OR 1.25 [95% CI，0.95-1.63]，P =0.11)。