The 5th minute PEA-AUC strongly predicted return of spontaneous circulation (AUC 0.7769) in a rat model of asphyxial cardiac arrest, with higher values correlating with better neurological recovery.
RCT (n=50)
Randomized
Does the area under the curve of pulseless electrical activity (PEA-AUC) predict return of spontaneous circulation and neurological outcomes in a rat model of asphyxial cardiac arrest?
In a rat model of asphyxial cardiac arrest, the area under the curve of pulseless electrical activity signals serves as a reliable early predictor of return of spontaneous circulation and correlates with better neurological recovery.
Effect estimate: AUC 0.7769
Introduction: Asphyxia-induced cardiac arrest(ACA) often results in severe ischemic injury to the sinoatrial(SA) node,with pulseless electrical activity(PEA) being the dominant and fatal arrhythmia.However, the prognostic significance of dynamic PEA waveform characteristics in ACA remains poorly defined.This study investigates whether the area under the curve of PEA(PEA-AUC) signals can predict return of spontaneous circulation(ROSC) and neurological outcomes in a rat model of ACA. Methods: Adult male Sprague-Dawley rats were randomized to 5-min(ACA-5,n=18) or 8-min(ACA-8,n=27) ACA.Sham animals(n=5) served as controls.Standardized cardiopulmonary resuscitation was initiated after arrest. Further, both ACA-5 and ACA-8 were stratified into ROSC(ACA-8-R,ACA-5-R) and non-ROSC(ACA-8-NR, ACA-5-NR) subgroups.PEA signals were recorded from the onset of cardiac arrest until the initiation of precordial compressions(PC),and the minute-by-minute PEA-AUC (mV·s) was calculated using MATLAB® (Version R2018a).Neurological deficit score(NDS) and serum neuron-specific enolase(NSE) were assessed at baseline and 24 hours post-ROSC.SA node histology was examined by H&E staining.Receiver operating characteristic(ROC) curves identified the optimal PEA-AUC threshold for predicting ROSC. Results: Baseline measurements and ROSC rate did not differ between ACA-5 and ACA-8.PEA-AUC declined with ischemia duration.ACA-8-R rats showed significantly higher PEA-AUC from 5 to 8 min post-arrest compared to ACA-8-NR(P< 0.05).ROC analysis identified the 5th minute PEA-AUC as a strong ROSC predictor(AUC = 0.7769),with 76.92% sensitivity,73.33% specificity,81% positive predictive value,and 68% negative predictive value.Compared with ACA-8-R,ACA-5-R animals required shorter CPR and less epinephrine.Also,the ACA-5-R group demonstrated reduced SA node injury,lower NSE and better NDS at 24 hours post-ROSC when compared with ACA-8-R (P< 0.05).PEA AUC at one minute prior to PC inversely correlated with both NDS(r=-0.501,P< 0.05) and NSE(r=-0.444,P< 0.05) at 24 hours post-ROSC. Conclusions: PEA-AUC at the 5th minute of ACA is a reliable early predictor of ROSC.Higher pre-resuscitation PEA-AUC correlates with less SA node injury and better neurological recovery.Real-time PEA monitoring may guide resuscitation strategies and outcome prediction in ACA.
Liu et al. (Sun,) conducted a rct in Asphyxia-induced cardiac arrest (n=50). 5-min or 8-min asphyxial cardiac arrest vs. Sham was evaluated on Return of spontaneous circulation (ROSC) (AUC 0.7769). The 5th minute PEA-AUC strongly predicted return of spontaneous circulation (AUC 0.7769) in a rat model of asphyxial cardiac arrest, with higher values correlating with better neurological recovery.