Johnson Nicholas J, Acker Michael, Hsu Cindy H, Desai Nimesh, Vallabhajosyula Prashanth, Lazar Sofiane, Horak Jiri, Wald Joyce, McCarthy Fenton, Rame Eduardo, Gray Kathryn, Perman Sarah M, Becker Lance, Cowie Doreen, Grossestreuer Anne, Smith Tom, Gaieski David F
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Resuscitation. 2014 Nov;85(11):1527-32. doi: 10.1016/j.resuscitation.2014.08.028. Epub 2014 Sep 6.
Extracorporeal life support (ECLS) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to conventional cardiopulmonary resuscitation.
We sought to describe our institution's experience with implementation of ECLS for out-of-hospital and emergency department (ED) cardiac arrests. Our primary outcome was survival to hospital discharge.
Consecutive patients placed on ECLS in the ED or within one hour of admission after out-of-hospital or ED cardiac arrest were enrolled at two urban academic medical centers in the United States from July 2007-April 2014.
During the study period, 26 patients were included. Average age was 40±15 years, 54% were male, and 42% were white. Initial cardiac rhythms were ventricular fibrillation or pulseless ventricular tachycardia in 42%. The average time from initial cardiac arrest to initiation of ECLS was 77 ± 51 min (range 12-180 min). ECLS cannulation was unsuccessful in two patients. Eighteen (69%) had complications related to ECLS, most commonly bleeding and ischemic events. Four patients (15%) survived to discharge, three of whom were neurologically intact at 6 months.
ECLS shows promise as a rescue strategy for refractory out-of-hospital or ED cardiac arrest but is not without challenges. Further investigations are necessary to refine the technique, patient selection, and ancillary therapeutics.
体外生命支持（ECLS）已被用作对传统心肺复苏无反应的心脏骤停患者的抢救策略。
我们试图描述我们机构在院外和急诊科（ED）心脏骤停患者中实施ECLS的经验。我们的主要结局是存活至出院。
2007年7月至2014年4月期间，在美国两家城市学术医疗中心，纳入了在急诊科或院外或急诊科心脏骤停后入院1小时内接受ECLS治疗的连续患者。
在研究期间，共纳入26例患者。平均年龄为40±15岁，54%为男性，42%为白人。初始心律为心室颤动或无脉性室性心动过速的患者占42%。从初始心脏骤停到开始ECLS的平均时间为77±51分钟（范围12 - 180分钟）。两名患者ECLS插管失败。18例（69%）出现与ECLS相关的并发症，最常见的是出血和缺血事件。4例患者（15%）存活至出院，其中3例在6个月时神经功能完好。
ECLS作为难治性院外或急诊科心脏骤停的抢救策略显示出前景，但并非没有挑战。需要进一步研究以完善技术、患者选择和辅助治疗方法。
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