Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Resuscitation. 2012 Aug;83(8):976-81. doi: 10.1016/j.resuscitation.2012.01.010. Epub 2012 Jan 21.
To investigate the predictors of adverse outcomes of extracorporeal life support (ECLS) in rescuing adult non-postcardiotomy cardiogenic shock or cardiac arrest (non-PC CS/CA).
This retrospective study included 60 adult patients receiving ECLS for non-PC CS/CA in a single institution between June 2003 and June 2010. The exclusion criteria were (1) pre-ECLS cardiac surgeries in the same admission and (2) age<18 years. Pre-ECLS and ECLS characteristics were compared in patients surviving to hospital discharge and those who did not. Mortalities after hospital discharge were also investigated.
Of the 38 patients weaned from ECLS, 32 survived to discharge. Acute myocardial infarction (AMI) and myocarditis were the most common aetiologies in this study. Forty patients experienced pre-ECLS conventional cardiopulmonary resuscitation (C-CPR) and 29 required an ECLS-assisted CPR (E-CPR). Thirteen patients who received E-CPR had profound anoxic encephalopathy later. In-hospital mortality was similar in AMI patients who underwent emergent coronary artery bypass grafting (CABG) after a failed percutaneous coronary intervention (PCI, 43%, 5/11) and those who underwent PCI only (58%, 7/12). Aetiologies other than myocarditis (odds ratio (OR) 11.0, 95% confidence interval (CI) 1.5-78.5), requirement for E-CPR (OR 5.6, 95% CI 1.5-22.0) and profound anoxic encephalopathy (OR 8.9, 95% CI 2.0-40.5) were predictors of in-hospital mortality. No risk factors of mortality after hospital discharge were identified.
ECLS was effective in bridging adults with non-PC CS/CA to definite treatments. Their prognosis depended on the cause of collapse and the severity of the post-cardiac arrest syndrome.
本研究旨在探讨体外生命支持（ECLS）治疗成人非心脏手术后心原性休克或心脏骤停（非 PC CS/CA）不良结局的预测因素。
本回顾性研究纳入了 2003 年 6 月至 2010 年 6 月期间在一家机构接受 ECLS 治疗的 60 例非 PC CS/CA 成人患者。排除标准为：（1）同一入院期间行 ECLS 前心脏手术；（2）年龄<18 岁。比较了存活至出院和未存活至出院患者的 ECLS 前和 ECLS 特征。还调查了出院后的死亡率。
在 38 例成功撤机的患者中，有 32 例存活至出院。本研究中最常见的病因是急性心肌梗死（AMI）和心肌炎。40 例患者接受了 ECLS 前常规心肺复苏（C-CPR），29 例需要 ECLS 辅助心肺复苏（E-CPR）。13 例接受 E-CPR 的患者后来出现了严重的缺氧性脑病。AMI 患者中，经皮冠状动脉介入治疗（PCI）失败后行急诊冠状动脉旁路移植术（CABG）的患者（43%，5/11）与仅行 PCI 的患者（58%，7/12）院内死亡率相似。除心肌炎以外的病因（比值比（OR）11.0，95%置信区间（CI）1.5-78.5）、需要 E-CPR（OR 5.6，95% CI 1.5-22.0）和严重缺氧性脑病（OR 8.9，95% CI 2.0-40.5）是院内死亡的预测因素。未发现出院后死亡的危险因素。
ECLS 可有效为非 PC CS/CA 的成人患者提供确定性治疗。他们的预后取决于心脏骤停的原因和心脏骤停后综合征的严重程度。
