Introduction

Respiratory failure is a common cause of pulseless electrical activity (PEA) and asystolic cardiac arrest, but the changes in heart rate (HR) pre-arrest are not well described. We describe HR dynamics prior to in-hospital cardiac arrest (IHCA) among PEA/asystole arrest patients with respiratory etiology.

Methods

In this retrospective study, we evaluated 139 patients with 3–24 hours of continuous electrocardiogram data recorded preceding PEA/asystole IHCA from 2010-2017. We identified respiratory failure cases by chart review and evaluated electrocardiogram data to identify patterns of HR changes, sinus bradycardia or sinus arrest, escape rhythms, and development right ventricular strain prior to IHCA.

Results

A higher proportion of respiratory cases (58/73, 79 %) fit a model of HR response characterized by tachycardia followed by rapid HR decrease prior to arrest, compared to non-respiratory cases (30/66, 45 %, p < 0.001). Among the 58 respiratory cases fitting this model, 36 (62 %) had abrupt increase in HR occurring 64 (IQR 23–191) minutes prior to arrest, while 22 (38 %) had stable tachycardia until time of HR decrease. Mean peak HR was 123 ± 21 bpm. HR decrease occurred 3.0 (IQR 2.0–7.0) minutes prior to arrest. Sinus arrest occurred during the bradycardic phase in 42/58 of cases; escape rhythms were present in all but 2/42 (5 %) cases. Right ventricular strain ECG pattern, when present, occurred at a median of 2.2 (IQR −0.05–17) minutes prior to onset of HR decrease.

Conclusion

IHCAs of respiratory etiology follow a model of HR increase from physiologic compensation to hypoxia, followed by rapid HR decrease prior to arrest.

中文翻译：

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院内无脉搏电活动或呼吸病因引起的心脏停搏前的持续心率动态

介绍

呼吸衰竭是无脉搏电活动 (PEA) 和心脏停搏的常见原因，但心率 (HR) 预停搏的变化没有得到很好的描述。我们描述了呼吸系统病因的 PEA/心脏停搏患者在院内心脏骤停 (IHCA) 之前的 HR 动态。

方法

在这项回顾性研究中，我们评估了 2010-2017 年在 PEA/心搏停止 IHCA 之前记录的 3-24 小时连续心电图数据的 139 名患者。我们通过图表审查确定呼吸衰竭病例并评估心电图数据，以确定 IHCA 前 HR 变化、窦性心动过缓或窦性停搏、逃逸节律和发展性右心室劳损的模式。

结果

与非呼吸系统病例相比，更高比例的呼吸系统病例 (58/73, 79 %) 符合 HR 反应模型，该模型的特征是心动过速，然后在骤停前 HR 快速下降 (30/66, 45 %, p  < 0.001) . 在符合该模型的 58 例呼吸系统病例中，36 例（62%）在心脏骤停前 64（IQR 23-191）分钟出现 HR 突然增加，而 22 例（38%）在 HR 下降前出现稳定的心动过速。平均峰值 HR 为 123 ± 21 bpm。HR 下降发生在逮捕前 3.0 (IQR 2.0–7.0) 分钟。42/58 的病例在心动过缓期发生窦性停搏；除 2/42 (5 %) 病例外，所有病例均存在逃逸节律。右心室应变 ECG 模式（如果存在）发生在 HR 下降开始前的中位数 2.2 (IQR -0.05-17) 分钟。

结论

呼吸系统病因的 IHCA 遵循从生理代偿到缺氧的 HR 增加模型，然后在停止前 HR 快速下降。