Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
Clin Res Cardiol. 2013 Sep;102(9):661-9. doi: 10.1007/s00392-013-0580-3. Epub 2013 May 9.
This study aimed to identify predictors of mortality in patients with out-of-hospital cardiac arrest (OHCA) undergoing in-hospital extracorporeal life support system (ECLS) treatment.
We retrospectively studied the characteristics and clinical outcomes of 28 patients (January 2010 and December 2011) with OHCA and veno-arterial ECLS implemented during ongoing cardiopulmonary resuscitation (CPR) upon admission to the cath lab. Baseline left ventricular ejection fraction (LVEF) was determined after ECLS implantation and then every 24 h during and after successful weaning from ECLS.
Overall 30-day survival rate was 39.3 % (11 of 28 patients). Baseline characteristics, initial laboratory measurements, and LVEF on admission were not significantly different between survivors and non-survivors. There was no difference regarding median CPR duration [survivors 44.0 min (IQR 31.0-45.0) vs. non-survivors 53.0 min (IQR 40.0-61.3); P = 0.23]. Door-to-ECLS implantation time was significantly longer in non-survivors [42.5 min (IQR 28.0-56.5) vs. 25.0 min (IQR 21.0-30.0); P < 0.01]. ECLS treatment duration was not significantly different between the two groups [survivors: 4.0 days (IQR 1.5-7.5) vs. non-survivors 6.5 days (IQR 1.0-8.0); P = 0.69]. LVEF significantly improved in survivors during ECLS treatment (mean ± SD survivor 47.5 ± 14.7 % vs. non-survivor 23.3 ± 14.9 %; P < 0.01). The door-to-ECLS implantation time was the only significant and independent predictor of 30-day mortality in multivariate Cox regression analysis (P = 0.04). Kaplan-Meier survival analysis showed a benefit favouring patients with a door-to-ECLS implantation time <30 min (log rank 6.29; P = 0.01).
A door-to-ECLS implantation time <30 min significantly improves 30-day outcomes in patients with OHCA.
本研究旨在确定行院内体外生命支持系统（ECLS）治疗的院外心脏骤停（OHCA）患者的死亡预测因素。
我们回顾性研究了 28 例 OHCA 患者的特征和临床结局，这些患者于 2010 年 1 月至 2011 年 12 月期间在入院至导管室期间接受持续心肺复苏（CPR）时进行了静脉-动脉 ECLS 治疗。在 ECLS 植入后确定左心室射血分数（LVEF）的基线水平，然后在成功脱机后每 24 小时进行一次。
总体 30 天生存率为 39.3%（28 例患者中的 11 例）。幸存者和非幸存者之间的基线特征、初始实验室测量和入院时的 LVEF 没有显著差异。CPR 持续时间中位数[幸存者 44.0 分钟（IQR 31.0-45.0）与非幸存者 53.0 分钟（IQR 40.0-61.3）；P=0.23]、门到 ECLS 植入时间在非幸存者中明显更长[42.5 分钟（IQR 28.0-56.5）与 25.0 分钟（IQR 21.0-30.0）；P<0.01]。两组 ECLS 治疗持续时间无显著差异[幸存者：4.0 天（IQR 1.5-7.5）与非幸存者 6.5 天（IQR 1.0-8.0）；P=0.69]。幸存者在 ECLS 治疗期间 LVEF 显著改善（均值±SD 幸存者 47.5±14.7%与非幸存者 23.3±14.9%；P<0.01）。多变量 Cox 回归分析显示，门到 ECLS 植入时间是 30 天死亡率的唯一显著和独立预测因素（P=0.04）。Kaplan-Meier 生存分析显示，门到 ECLS 植入时间<30 分钟的患者 30 天预后明显改善（对数秩检验 6.29；P=0.01）。
门到 ECLS 植入时间<30 分钟可显著改善 OHCA 患者的 30 天结局。
