体外心肺复苏术治疗儿科院内心搏骤停患者 11 年经验。
Eleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest.
机构信息
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
Resuscitation. 2012 Jun;83(6):710-4. doi: 10.1016/j.resuscitation.2012.01.031. Epub 2012 Feb 1.
PURPOSE
The study aims to describe 11 years of experience with extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital paediatric cardiac arrest in a university affiliated tertiary care hospital.
METHODS
Paediatric patients who received extracorporeal membrane oxygenation (ECMO) during active extracorporeal cardiopulmonary resuscitation (ECPR) at our centre from 1999 to 2009 were included in this retrospective study. The results from three different cohorts (1999-2001, 2002-2005 and 2006-2009) were compared. Survival rates and neurological outcomes were analysed. Favourable neurological outcome was defined as paediatric cerebral performance categories (PCPC) 1, 2 and 3.
RESULTS
We identified 54 ECPR events. The survival rate to hospital discharge was 46% (25/54), and 21 (84%) of the survivors had favourable neurological outcomes. The duration of CPR was 39±17 min in the survivors and 52±45 min in the non-survivors (p=NS). The patients with pure cardiac causes of cardiac arrest had a survival rate similar to patients with non-cardiac causes (47% (18/38) vs. 44% (7/16), p=NS). The non-survivors had higher serum lactate levels prior to ECPR (13.4±6.4 vs. 8.8±5.1 mmol/L, p<0.01) and more renal failure after ECPR (66% (19/29) vs. 20% (5/25), p<0.01). The patients resuscitated between 2006 and 2009 had shorter durations of CPR (34±13 vs. 78±76 min, p=0.032) and higher rates of survival (55% (16/29) vs. 0% (0/8), p=0.017) than those resuscitated between 1999 and 2002.
CONCLUSIONS
In our single-centre experience with ECPR for paediatric in-hospital cardiac arrest, the duration of CPR has become shorter and outcomes have improved in recent years. Higher pre-ECPR lactate levels and the presence of post-ECPR renal failure were associated with increased mortality. The presence of non-cardiac causes of cardiac arrest did not preclude successful ECPR outcomes. The duration of CPR was not significantly associated with poor outcomes in this study.
目的
本研究旨在描述一家大学附属三级护理医院 11 年来在院内儿科心搏骤停中进行体外心肺复苏（ECPR）的经验。
方法
本回顾性研究纳入了 1999 年至 2009 年期间在我院接受体外膜氧合（ECMO）治疗的主动体外心肺复苏（ECPR）期间接受 ECMO 的儿科患者。比较了三个不同队列（1999-2001 年、2002-2005 年和 2006-2009 年）的结果。分析了生存率和神经结局。良好的神经结局定义为小儿脑功能分类（PCPC）1、2 和 3。
结果
我们确定了 54 例 ECPR 事件。出院时的生存率为 46%（25/54），21 例（84%）幸存者有良好的神经结局。幸存者的 CPR 持续时间为 39±17 分钟，非幸存者为 52±45 分钟（p=NS）。心搏骤停的纯心脏原因患者的生存率与非心脏原因患者相似（47%（18/38）与 44%（7/16），p=NS）。非幸存者在 ECPR 前的血清乳酸水平更高（13.4±6.4 vs. 8.8±5.1 mmol/L，p<0.01），ECPR 后更易发生肾功能衰竭（66%（19/29）与 20%（5/25），p<0.01）。2006 年至 2009 年复苏的患者 CPR 持续时间更短（34±13 与 78±76 分钟，p=0.032），生存率更高（55%（16/29）与 0%（0/8），p=0.017），与 1999 年至 2002 年复苏的患者相比。
结论
在我们对院内儿科心搏骤停进行 ECPR 的单中心经验中，近年来 CPR 的持续时间缩短，结果有所改善。较高的 ECPR 前乳酸水平和 ECPR 后肾功能衰竭的存在与死亡率增加相关。心搏骤停的非心脏原因并不能排除成功的 ECPR 结果。在这项研究中，CPR 的持续时间与不良结果没有显著相关性。
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