Younger J G, Schreiner R J, Swaniker F, Hirschl R B, Chapman R A, Bartlett R H
Extracorporeal Life Support Service, University of Michigan, Ann Arbor, USA.
Acad Emerg Med. 1999 Jul;6(7):700-7. doi: 10.1111/j.1553-2712.1999.tb00438.x.
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.
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.
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.
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.
心脏骤停期间心肺功能的体外支持（静脉-动脉灌注，即体外心肺复苏[ECPR]）已被提倡作为提高心脏骤停后生存率的一种手段。作者回顾性分析了他们所在机构七年中应用此干预措施的经验。
心脏骤停或骤停后即刻的急诊科患者及住院患者被视为候选对象。采用静脉-动脉旁路进行ECPR，并持续进行直至患者恢复足够的心肺功能以脱离该设备，或直至其病情被判定无法恢复。
25例患者尝试进行ECPR，21例成功实施。4例患者（16%）从ECPR转为心室辅助装置，其中2例存活并等待移植。另有7例患者出院，总体生存率为36%。由于接受治疗的儿童均未存活，幸存者有年龄偏大的趋势（幸存者40±14岁，非幸存者33±15岁，p = 0.29）。幸存者的传统心肺复苏持续时间较短（幸存者21±16分钟，非幸存者43±32分钟，p = 0.04），体外支持持续时间也较短（幸存者44±21小时，非幸存者87±96小时，p = 0.18）。仅在病情适合确定性治疗干预的患者中观察到生存情况，特别是因呼吸或肺栓塞疾病导致的心脏骤停患者。虽然在急诊科接受治疗的5例患者中有4例得到成功支持，但均未存活至出院。
对于部分患有可逆性疾病的患者，体外心肺复苏可成功用于治疗心脏骤停。有必要对其最恰当的应用进行进一步研究。
