Bednarczyk Joseph M, White Christopher W, Ducas Robin A, Golian Mehrdad, Nepomuceno Roman, Hiebert Brett, Bueddefeld Derek, Manji Rizwan A, Singal Rohit K, Hussain Farrukh, Freed Darren H
Resuscitation. 2014 Dec;85(12):1713-9. doi: 10.1016/j.resuscitation.2014.09.026.
Among patients with reversible conditions who sustain cardiac arrest, extracorporeal membrane oxygenation (ECMO) may support end organ perfusion while bridging to definitive therapy.
A single center retrospective review (February 2008–September 2013) of adults receiving ECMO for cardiac arrest ≥15 min duration refractory to conventional management (E-CPR) or profound cardiogenic shock following IHCA (E-CS) was conducted. The primary outcome was 30-day survival with good neurologic function defined as a cerebral performance category (CPC) of 1–2. Secondary outcomes included intensive care unit (ICU) and hospital length of say, duration of mechanical ventilation, and univariate predictors of 30-day survival with favorable neurologic function.
Thirty-two patients (55 ± 11 years, 66% male) were included of which 22 (69%) received E-CPR and 10 (31%) received E-CS following return of spontaneous circulation (ROSC). Cardiac arrest duration was 48.8 ± 21 min for those receiving E-CPR and 25 ± 23 min for the E-CS group. Patients received ECMO support for 70.7 ± 47.6 h. Death on ECMO support occurred in 7 (21.9%) patients, while 7 (21.9%) were bridged to another form of mechanical circulatory support, and 18 (56.3%) were successfully decannulated. ICU length of stay was 7.5 [3.3–14] days and ICU survival occurred in 16 (50%) of patients. 30-Day survival was 5 (50%) in the E-CS group, 10 (45.4%) in the E-CPR group, and 15 (47%) overall. All survivors had CPC 1–2 neurologic status.
In this single center experience, the use of resuscitative ECMO was associated with neurologically favorable 30-day survival in 47% of patients with prolonged IHCA (H2012:172).
在患有可逆性疾病且发生心脏骤停的患者中，体外膜肺氧合（ECMO）可在过渡到确定性治疗期间支持终末器官灌注。
对2008年2月至2013年9月期间接受ECMO治疗的成年人进行单中心回顾性研究，这些患者心脏骤停持续时间≥15分钟，对传统治疗（体外心肺复苏[E-CPR]）无效，或在院内心脏骤停后发生严重心源性休克（E-CS）。主要结局是30天存活且神经功能良好，定义为脑功能分类（CPC）为1-2级。次要结局包括重症监护病房（ICU）住院时间和住院时间、机械通气时间，以及30天存活且神经功能良好的单因素预测指标。
纳入32例患者（年龄55±11岁，66%为男性），其中22例（69%）接受E-CPR，10例（31%）在自主循环恢复（ROSC）后接受E-CS。接受E-CPR的患者心脏骤停持续时间为48.8±21分钟，E-CS组为25±23分钟。患者接受ECMO支持70.7±47.6小时。7例（21.9%）患者在ECMO支持期间死亡，7例（21.9%）过渡到另一种形式的机械循环支持，18例（56.3%）成功拔管。ICU住院时间为7.5[3.3-14]天，16例（50%）患者在ICU存活。E-CS组30天存活率为5例（50%），E-CPR组为10例（45.4%），总体为15例（47%）。所有存活者的CPC神经功能状态为1-2级。
在这项单中心经验中，47%的院内心脏骤停时间延长患者使用复苏性ECMO后30天存活且神经功能良好（H2012:172）。
