Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Resuscitation. 2015 Jul;92:70-6. doi: 10.1016/j.resuscitation.2015.04.016. Epub 2015 Apr 29.
Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution.
This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared.
The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 ± 49.6 min vs 34.3 ± 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0. 0998) at 1 year after discharge.
The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.
难治性心室颤动是急诊科遇到的一种危及生命的节律，对常规心肺复苏（CPR）有抵抗力。尽管以前的报告表明，体外 CPR 可改善长时间心脏骤停患者的临床结局，但这种治疗难治性心室颤动的新策略的有效性尚不清楚。我们旨在比较我院难治性心室颤动患者接受常规 CPR 或体外 CPR 治疗的临床结局。
这是一项回顾性图表研究，来自一家三级转诊医疗中心的急诊科。我们确定了 2011 年 9 月至 2013 年 9 月期间因心室颤动导致心脏骤停的 209 名患者。其中，60 名患者因复苏 10 分钟以上而出现难治性心室颤动。接受常规 CPR（包括除颤、胸外按压和复苏药物，C-CPR，n = 40）或 CPR 加体外 CPR（E-CPR，n = 20）的患者比较心室颤动患者的临床结局。
总存活率为 35%，18.3%的患者出院时神经功能良好。E-CPR 组的 CPR 持续时间明显长于 C-CPR 组（69.90 ± 49.6 min 比 34.3 ± 17.7 min，p = 0.0001）。接受 E-CPR 的患者自主循环持续恢复的比例明显更高（95.0%比 47.5%，p = 0.0009），出院时神经功能良好的比例也更高（40.0%比 7.5%，p = 0.0067）。E-CPR 组的存活率（出院时 50%比 27.5%，p = 0.1512）和出院后 1 年时（50%比 20%，p = 0.0998）均较高。
本研究中整体存活率为 35%，表明急诊科难治性心室颤动的治疗仍然具有挑战性。接受 E-CPR 的难治性心室颤动患者的生存率和神经功能改善均有升高趋势，优于接受 C-CPR 的患者。
