Stub Dion, Bernard Stephen, Pellegrino Vincent, Smith Karen, Walker Tony, Sheldrake Jayne, Hockings Lisen, Shaw James, Duffy Stephen J, Burrell Aidan, Cameron Peter, Smit De Villiers, Kaye David M
Baker IDI Heart and Diabetes Research Institute, Australia; University of Washington, United States; St. Paul's Hospital, Vancouver, Canada.
Alfred Hospital, Australia; Monash University, Australia; Ambulance Victoria, Australia.
Resuscitation. 2015 Jan;86:88-94. doi: 10.1016/j.resuscitation.2014.09.010. Epub 2014 Oct 2.
Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia.
The CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a single center, prospective, observational study conducted at The Alfred Hospital. The CHEER protocol was developed for selected patients with refractory in-hospital and out-of-hospital cardiac arrest and involves mechanical CPR, rapid intravenous administration of 30 mL/kg of ice-cold saline to induce intra-arrest therapeutic hypothermia, percutaneous cannulation of the femoral artery and vein by two critical care physicians and commencement of veno-arterial ECMO. Subsequently, patients with suspected coronary artery occlusion are transferred to the cardiac catheterization laboratory for coronary angiography. Therapeutic hypothermia (33 °C) is maintained for 24h in the intensive care unit.
There were 26 patients eligible for the CHEER protocol (11 with OHCA, 15 with IHCA). The median age was 52 (IQR 38-60) years. ECMO was established in 24 (92%), with a median time from collapse until initiation of ECMO of 56 (IQR 40-85) min. Percutaneous coronary intervention was performed on 11 (42%) and pulmonary embolectomy on 1 patient. Return of spontaneous circulation was achieved in 25 (96%) patients. Median duration of ECMO support was 2 (IQR 1-5) days, with 13/24 (54%) of patients successfully weaned from ECMO support. Survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14/26 (54%) patients.
A protocol including E-CPR instituted by critical care physicians for refractory cardiac arrest which includes mechanical CPR, peri-arrest therapeutic hypothermia and ECMO is feasible and associated with a relatively high survival rate.
许多心脏骤停患者对标准心肺复苏无反应。在难治性心脏骤停的管理中，利用静脉-动脉体外膜肺氧合辅助心肺复苏（E-CPR）的兴趣日益浓厚。我们描述了在澳大利亚墨尔本建立难治性心脏骤停E-CPR项目的初步经验。
CHEER试验（机械心肺复苏、低温、体外膜肺氧合和早期再灌注）是在阿尔弗雷德医院进行的一项单中心、前瞻性观察性研究。CHEER方案是为选定的院内和院外难治性心脏骤停患者制定的，包括机械心肺复苏、快速静脉注射30 mL/kg冰冷盐水以诱导心脏骤停期间的治疗性低温、由两名重症监护医生经皮穿刺股动脉和静脉并开始静脉-动脉体外膜肺氧合。随后，疑似冠状动脉闭塞的患者被转移至心脏导管实验室进行冠状动脉造影。在重症监护病房将治疗性低温（33℃）维持24小时。
有26例患者符合CHEER方案标准（11例院外心脏骤停，15例院内心脏骤停）。中位年龄为52岁（四分位间距38 - 60岁）。24例（92%）患者建立了体外膜肺氧合，从心脏骤停至开始体外膜肺氧合的中位时间为56分钟（四分位间距40 - 85分钟）。11例（42%）患者接受了经皮冠状动脉介入治疗，1例患者接受了肺动脉血栓切除术。25例（96%）患者实现了自主循环恢复。体外膜肺氧合支持的中位持续时间为2天（四分位间距1 - 5天），24例患者中有13例（54%）成功脱离体外膜肺氧合支持。14/26（54%）例患者存活至出院且神经功能完全恢复（CPC评分1）。
由重症监护医生制定的包括E-CPR的方案，用于难治性心脏骤停，包括机械心肺复苏、心脏骤停期间的治疗性低温和体外膜肺氧合，是可行的，且生存率相对较高。
