体外心肺复苏启动前因素对患者预后的影响

目的:分析体外心肺复苏（extracorporeal cardiopulmonary resuscitation,ECPR）启动前因素对患者预后的影响,以探讨ECPR的干预时机和改进策略。方法:回顾性分析2018年7月至2021年4月在湖南师范大学附属第一医院（湖南省人民医院）行ECPR的29例患者。按患者是否存活出院分为生存组( n=13)及死亡组( n=16),分析两组常规心肺复苏（conventional cardiopulmonary resuscitation,CCPR）时间（开始心肺复苏到体外膜肺氧合运转的时间）、ECPR前初始心律、院外及院内心搏骤停的构成比、外院转运病例构成比。按CCPR时间分为≤45 min组、45~60 min组及>60 min组分别比较其出院存活率及持续自主循环恢复（sustained return of spontaneous circulation,ROSC）率。本院院内心搏骤停患者按心搏骤停（cardiac arrest,CA）发生地点分为本科室亚组和其他科室亚组,比较其存活率。 结果:29例患者总体生存率44.83%,体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）平均辅助时长114（33.5,142.5） h,CCPR平均时长60（44.5,80） min。生存组ECMO辅助时间（140.15±44.80）h较死亡组长（ P=0.001）,生存组CCPR时间明显低于死亡组（ P=0.010）。初始心律为可除颤心律组生存率更高（ P=0.010）。OHCA较IHCA患者病死率高（ P=0.020）。外院转运病例病死率高于本院病例（ P=0.025）。CCPR时间≤45min、45~60 min、>60 min三组患者出院生存率依次递减（ P=0.001）,ROSC率依次递减（ P=0.001)。本院院内心搏骤停患者,CA发生地点在本科室（急诊医学科）组与其他科室组生存率差异无统计学意义（ P=0.54）。 结论:ECPR出院存活率高于国内外报道的CCPR存活率,ECPR对难治性心搏骤停是有效的。ECPR的预后跟CCPR时间、CA初始心律、CA发生地点明显相关,提高ECPR存活率需加强宣教及团队建设。     

体外膜肺氧合辅助心肺复苏治疗急性心肌梗死的主要肾脏不良事件

目的调查体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)治疗急性心肺梗死(acute myocardial infarction, AMI)的90 d主要肾脏不良事件(major adverse kidney events, MAKE)。方法回顾性分析南京医科大学第一附属医院急诊中心2015年4月至2023年4月75例AMI-ECPR的资料, 以90 d存活/死亡、有/无RRT(renal replacement therapy)、是否AKI(acute kidney injury)原因启动RRT进行分组, 比较年龄、性别、查尔森合并症指数、IHCA/OHCA(out-of-hospital/in-hospital cardiac arrest)、初始心律、Gensini评分、ECPR初始血气pH和乳酸值、无灌流时间、心脏骤停至ECMO(extracorporeal membrane oxygenation)转流时间(CA-Pump On时间)、ECMO和RRT治疗时间、90 d存活率等的差异, 并随访幸存...     

体外膜肺氧合辅助心肺复苏治疗成人心脏性猝死的临床评价

目的总结体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)治疗心脏性猝死(sudden cardiac death, SCD)的经验和效果。方法回顾性分析南京医科大学第一附属医院急诊中心2015年4月至2023年4月120例成人SCD-ECPR的资料, 以90 d存活/死亡、OHCA/IHCA(out-of-hospital/in-hospital cardiac arrest)、是否为急性心肌梗死(acute myocardial infarction, AMI)和心脏骤停至ECMO(extracorporeal membrane oxygenation)转流时间(CA-Pump On时间)60 min为界进行分组, 比较年龄、性别、查尔森合并症指数、IHCA/OHCA、初始心律、无灌流时间、CA-Pump On时间、ECMO撤离成功率、90 d存活率、ECMO治疗时间的差异。结果①114例SCD-ECPR患者纳入分析, 90 d存活45例(39.5%), 其中40例(88.9%)神经功能预后良好。②90 ...     

体外心肺复苏患者预后不良的危险因素

目的分析体外心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)患者的临床特征, 探索导致患者预后不良的危险因素。方法回顾性分析2020年1月至2023年5月收住本院接受ECPR的95例患者的临床资料。根据出院时的存活状态分为存活组和死亡组, 比较两组临床资料的差异, 探讨和死亡及预后不良相关的危险因素。通过二元Logistic回归分析确定与患者死亡相关的危险因素。结果本研究共纳入95例ECPR患者, 出院时死亡62例(65.3%), 存活33例(34.7%), 与存活组患者相比, 死亡组患者低血流时间[40(30, 52.5) minvs. 30(24.5, 40)min ]和总停搏时间[40 (30, 52.5) minvs. 30 (24.5, 40)min]更长、总住院时间[3 (2, 7.25) dvs. 19 (13.5, 31)d]和体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)辅助时间[26.5 (17, 50)vs. 62 (44, 80.5), h]更短,...     

区域性复苏中心体外心肺复苏治疗难治性心脏骤停的回顾性分析

目的 本中心为区域性体外心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)中心,回顾体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)治疗难治性心脏骤停(cardiac arrest, CA)患者临床数据,为临床的救治提供经验。方法 回顾性分析2013年5月至2022年12月在南方医科大学顺德医院因难治性CA患者接受ECMO治疗的临床资料。本中心的院内CA是在床边建立ECMO;院外CA或区域内合作医院的院内CA是建立ECMO后再转运至本中心救治。结果 共纳入并分析75例难治性CA患者。ECMO撤机成功率33.3%,生存出院率25.3%,神经系统预后良好率22.6%。生存组初始心律失常为可电复律的比例高于死亡组(73.7%vs. 35.7%,χ²=10.008,P=0.002);生存组年龄小于死亡组(岁：43.5±11.9 vs. 51.9±16.6,t=-2.024,P=0.047),差异有统计学意义(P<0.05)。两组CA地点、旁观者实施CPR,...     

体外心肺复苏在心肺复苏中的应用————《成人体外膜氧合循环辅助专家共识》解读

心脏骤停是急诊科常见情况,传统心肺复苏（conventional cardiopulmonary resuscitation,CCPR）效果差,体外心肺复苏（extracorporeal cardiopulmonary resuscitation,ECPR）治疗CA患者存活率高,但ECPR开展难度大,如何做到科学精准成为关键。开展ECPR的医院需要有全天候24小时值班的ECMO团队,团队成员经过统一培训,用尽可能短的时间建立ECMO;ECMO仪器、耗材及相关物品应有专门的地方放置,专人保管,定期查验,ECMO管路可提前进行预冲并储存备用;经皮穿刺置管具有简单、快速等优点,且置管部位出血和感染的概率小,建议超声引导下进行。     

心脏骤停患者应用体外膜肺氧合辅助心肺复苏的护理

目的：总结心脏骤停应用体外膜肺氧合辅助心肺复苏( Extracorporeal Cardiopulmonary Resuscita-tion, ECPR)的护理经验。方法回顾分析2011年1月1日至2015年12月31日,47例成人心脏手术后患者因心脏骤停常规心肺复苏( Cardiopulmonary Resuscitation, CPR)10 min无法恢复自主循环,接受体外膜肺氧合( Ex-tracorporeal Membrane Oxygenation, ECMO)紧急生命支持的资料,其中男35例,女12例,年龄42~76岁,平均(60±8)岁。结果29例(61.7％)患者成功撤离ECMO 辅助,其中20例(42.6％)存活出院。 CPR 时间15~485 min(中位时间95 min),ECMO辅助后全部患者均恢复自主心律,ECMO辅助时间9~224 h(中位时间95 h), ICU停留时间0.8~20 d(中位时间7 d),随着CPR时间的延长,心脏骤停患者ECPR存活率逐渐降低。结论ECMO可提供紧急循环及呼吸支持,可挽救部分常规CPR复苏困难的患者生命。 ECMO专业护理人员是ECMO小组中重要的组成部分,对ECMO的维护和正常运转起重要作用,专业的护理对于提高脱机率和患者生存率非常重要。     

78例体外心肺复苏患者的临床特点回顾性分析

目的:总结体外膜肺氧合辅助心肺复苏患者(extracorporeal cardiopulmonary resuscitation, ECPR)的临床特点并分析临床结局的影响因素。方法:回顾性纳入2015年03月至2020年12月南京医科大学第一附属医院(江苏省人民医院)急诊医学科收治的ECPR患者78例。根据患者的临床结局分为存活组和死亡组。分别比较两组的基本资料,CPR资料及ECPR启动前实验室检验。结果:共纳入ECPR患者78例,男性51例,女性27例,存活23例,其中男性10例,女性13例。组间患者年龄、体质量指数、基础疾病(高血压病、糖尿病、冠心病)均差异无统计学意义(均 P>0.05)。存活组男性患者比例低于死亡组( P=0.017)。同时存活组患者SAVE（survival after veno-arterial ECMO）评分显著高于死亡组[(-1.57±4.15) vs. (-9.36±5.36), P<0.001]。存活组中旁观者心肺复苏比例高于死亡组( P=0.014)。存活组ECPR启动前存活组血清AST、ALT、Cr水平均低于死亡组( P<0.05)。二分类多因素Logistic回归分析结果显示旁观者心肺复苏( OR=0.114,95% CI: 0.015~0.867, P=0.036)和SAVE评分( OR=0.625,95% CI: 0.479~0.815, P=0.001)是预测ECPR患者ICU死亡的独立危险因素。 结论:单中心资料显示ECPR是救治呼吸心搏骤停患者的有效手段,旁观者心肺复苏、SAVE评分是预测ECPR患者ICU死亡的独立危险因素。     

SAVE评分联合上机24 h乳酸对体外心肺复苏患者预后的预测价值分析

目的探讨静脉-动脉体外膜肺氧合后生存(survival after veno-arterial ECMO, SAVE)评分联合上机24 h乳酸对体外心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)患者预后的预测价值。方法回顾分析2017年4月至2021年6月间于南京医科大学第一附属医院急诊科行ECPR治疗的患者共59例。根据28 d生存情况将患者分为死亡组(n=36)和存活组(n=23)。分析基线资料差异,并通过多因素Logistic回归分析确定ECPR患者28 d死亡的相关危险因素。利用受试者工作特征(ROC)曲线评估SAVE评分、上机24 h乳酸及两者联合检测对ECPR患者28 d死亡风险的预测价值。结果 ECPR患者28 d生存率为39%(23/59)。死亡组SAVE评分明显低于存活组[(-11.67±4.60)vs. (-2.43±4.77), P<0.001], 上机24 h乳酸明显高于存活组[5.94(3.37, 12.40)mmol/Lvs. 1.65(1.07, 3.15)mmol/L, P<0...     

体外生命支持中心建设对体外膜氧合技术治疗患者预后研究

目的探讨医院体外生命支持中心的建立对体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)技术治疗患者生存率的影响。方法通过回顾2015年1月至2021年7月青岛大学附属医院收治的158例应用ECMO技术治疗的患者为研究对象。将患者分为2组, 对照组为2015年1月至2020年8月体外生命支持中心成立前ECMO治疗患者, 共85例;观察组体外生命支持中心成立后2020年9月至2021年7月ECMO治疗患者, 共73例。比较两组ECMO救治患者总体生存率, VV-ECMO及VA-ECMO救治生存率、存活患者ECMO支持时间及患者住院费用、体外心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)建立时间等差异。结果与体外生命支持中心成立前相比, 体外生命支持中心成立后ECMO治疗患者总体生存率(52.9%vs. 65.7%, P=0.019)以及VA-ECMO救治生存率明显提高(53.2%vs. 71.7%, P=0.042), ECMO救治存活患者ECMO支持时间[(16.78±11....     

Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?

Background

Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole.

Emergency Physician-Initiated Resuscitative Extracorporeal Membrane Oxygenation

BackgroundExtracorporeal membrane oxygenation (ECMO) has several applications as a resuscitative intervention, including extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is rarely initiated in the emergency department (ED) by emergency physicians outside regional academic institutions.ObjectivesTo evaluate whether ECPR improves clinical outcomes after cardiac arrest when initiated by emergency physicians (EPs) in a nonacademic hospital.Methods and MaterialsWe performed a retrospective analysis of prospectively identified consecutive EP-initiated ECMO subjects from a single community hospital over a 7-year period. Logistic regression and propensity models tested the association between ECPR and survival to hospital discharge compared with concurrent ECPR-eligible control subjects.ResultsOver 7 years (2010–2017), EPs initiated ECMO on 58 subjects; 44 (76%) were venoarterial cases (43 ECPR) initiated in the ED. Of those, 11 (25%) survived to discharge (n = 9 with cerebral performance category score 1) and most were still alive after 5 years (66%). Adjusting for known covariates, ECPR subjects were more likely than concurrent controls to survive to discharge (odds ratio 8.4; 95% confidence interval 1.2–60.4). Propensity analysis revealed a favorable trend toward survival to discharge after ECPR (odds ratio 2.0; 95% confidence interval 0.51–7.8).ConclusionsEmergency physicians initiated ECMO with promising clinical outcomes. Prospective trials are needed to define the efficacy, safety, and cost-effectiveness of EP-initiated ECMO.     

Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic

Purpose

To describe the technical challenges, efficacy, complications and maternal and infant outcomes associated with extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS) in pregnant or postpartum patients during the 2009 H1N1 pandemic.

Methods

Twelve critically ill pregnant and postpartum women were included in this retrospective observational study on the application of ECMO for the treatment of severe ARDS refractory to standard treatment. The study was conducted at seven tertiary hospitals in Australia and New Zealand.

Results

Of the 12 patients treated with ECMO, 7 (58%) were pregnant and 5 (42%) were postpartum. Their median (interquartile range [IQR]) age was 29 (26?C33)?years, 6 (50%) were obese. Two patients were initially treated with veno-arterial (VA) ECMO. All others received veno-venous (VV) ECMO with one or two drainage cannulae. ECMO circuit-related complications were rare, circuit change was needed in only two cases and there was no sudden circuit failure. On the other hand, bleeding was common, leading to relatively large volumes of packed red blood cell transfusion (median [IQR] volume transfused was 3,499 [1,451?C4,874]?ml) and was the main cause of death (three cases). Eight (66%) patients survived to discharge and seven were ambulant, with normal oxygen saturations. The survival rate of infants whose mothers received ECMO was 71% and surviving infants were discharged home with no sequelae.

Conclusions

The use of ECMO for severe ARDS in pregnant and postpartum women was associated with a 66% survival rate. The most common cause of death was bleeding. Infants delivered of mothers who had received ECMO had a 71% survival rate and, like their mothers, had no permanent sequelae at hospital discharge.     

Decision-tree model for predicting outcomes after out-of-hospital cardiac arrest in the emergency department

Introduction

Estimation of outcomes in patients after out-of-hospital cardiac arrest (OHCA) soon after arrival at the hospital may help clinicians guide in-hospital strategies, particularly in the emergency department. This study aimed to develop a simple and generally applicable bedside model for predicting outcomes after cardiac arrest.

Methods

We analyzed data for 390,226 adult patients who had undergone OHCA, from a prospectively recorded nationwide Utstein-style Japanese database for 2005 through 2009. The primary end point was survival with favorable neurologic outcome (cerebral performance category (CPC) scale, categories 1 to 2 [CPC 1 to 2]) at 1 month. The secondary end point was survival at 1 month. We developed a decision-tree prediction model by using data from a 4-year period (2005 through 2008, n = 307,896), with validation by using external data from 2009 (n = 82,330).

Results

Recursive partitioning analysis of the development cohort for 10 predictors indicated that the best single predictor for survival and CPC 1 to 2 was shockable initial rhythm. The next predictors for patients with shockable initial rhythm were age (<70 years) followed by witnessed arrest and age (>70 years) followed by arrest witnessed by emergency medical services (EMS) personnel. For patients with unshockable initial rhythm, the next best predictor was witnessed arrest. A simple decision-tree prediction mode permitted stratification into four prediction groups: good, moderately good, poor, and absolutely poor. This model identified patient groups with a range from 1.2% to 30.2% for survival and from 0.3% to 23.2% for CPC 1 to 2 probabilities. Similar results were observed when this model was applied to the validation cohort.

Conclusions

On the basis of a decision-tree prediction model using four prehospital variables (shockable initial rhythm, age, witnessed arrest, and witnessed by EMS personnel), OHCA patients can be readily stratified into the four groups (good, moderately good, poor, and absolutely poor) that help predict both survival at 1 month and survival with favorable neurologic outcome at 1 month. This simple prediction model may provide clinicians with a practical bedside tool for the OHCA patient''s stratification in the emergency department.     

体外膜肺氧合心肺复苏患者死亡的危险因素

目的:分析体外膜肺氧合心肺复苏（extracorporeal cardiopulmonary resuscitation, ECPR）死亡患者的临床特征,探索该类患者死亡相关的危险因素。方法:回顾性分析2014年9月至2019年9月收住本院及杭州市第一人民医院接受体外心肺复苏的60例心搏骤停患者的临床资料。将患者分为存...     

Improving survival after in-hospital cardiac arrest: the Australian experience.

BACKGROUND: Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training. OBJECTIVES: To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest. METHODS: An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model. RESULTS: Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge. CONCLUSIONS: The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.     

Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: Propensity analysis of three-year data

Aim

Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR.

Methods

Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10 min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome.

Results

There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p = 0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p = 0.634, 95% CI: 0.453-1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p = 0.093, 95% CI: 0.333-1.088).

Conclusions

This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted.     

Extracorporeal life support associated with hypothermia and normoxemia in refractory cardiac arrest

Aim

We describe a 1-year experience with extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) associated with intra-arrest hypothermia and normoxemia.

Methods

Since January 1st 2012, ECPR has been applied in our hospital to all patients less than 65 years of age and without major co-morbidities who develop refractory cardiac arrest (CA) with bystander CPR. Over a 1-year period of observation, we recorded 28-day survival with intact neurological outcome and the rate of organ donation.

Results

During the observational period, 24 patients were treated with ECPR, with a median age of 48 years. Ten patients had IHCA. Acute coronary syndrome and/or major arrhythmias were the main cause of arrest. Intra-arrest cooling was used in 17 patients; temperature on ECMO initiation in these patients was 32.9 °C [32–34]. The time from collapse to ECPR was 58 min [45–70] and was shorter in survivors than in non-survivors (41 min [39–58] vs. 60 min [55–77], p = 0.059). Non-survivors were more likely to have coagulopathy and received more blood transfusions. Six patients (25%) survived with good neurological outcome at day 28. Four patients with irreversible brain damage had organ function suitable for donation.

Conclusion

ECPR provided satisfactory survival rates with good neurologic recovery in refractory CA for both IHCA and OHCA. ECMO may help rapidly stabilise systemic haemodynamic status and restore organ function.     

Extracorporeal Resuscitation of Cardiac Arrest

OBJECTIVE: Extracorporeal support of heart and lung function (venoarterial perfusion) during cardiac arrest (ECPR) has been advocated as a means of improving survival following cardiac arrest. The authors retrospectively reviewed their institution's seven-year experience with this intervention. METHODS: Emergency department patients and inpatients in cardiac arrest or immediately postarrest were considered candidates. ECPR was instituted using venoarterial bypass and was continued until patients regained sufficient cardiopulmonary function to allow weaning from the device or until their condition was deemed irrecoverable. RESULTS: ECPR was attempted in 25 patients and successfully instituted in 21. Four patients (16%) were converted from ECPR to ventricular assist devices, two of whom survived and await transplantation. Seven additional patients were discharged from the hospital, resulting in an overall survival of 36%. Because none of the children treated survived, there was a trend toward higher age among survivors (survivors 40 +/- 14 yr, nonsurvivors 33 +/- 15 yr, p = 0.29). The duration of conventional CPR was shorter among survivors (survivors 21 +/- 16 min, nonsurvivors 43 +/- 32 min, p = 0.04), as was the duration of extracorporeal support (survivors 44 +/- 21 hr, nonsurvivors 87 +/- 96 hr, p = 0.18). Survival was seen only in patients whose conditions were amenable to a definitive therapeutic intervention, particularly cardiac arrest due to respiratory or pulmonary embolic disease. While four of the five patients treated in the ED were successfully supported, none survived to discharge. CONCLUSION: In select patients with reversible disease, extracorporeal CPR can be used to successfully treat cardiac arrest. Further investigation into its most appropriate application is warranted.