Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Italy
Intensive Care Unit of Heart and Vessels Department, Azienda Ospedaliero-Universitaria Careggi, Italy.
Eur Heart J Acute Cardiovasc Care. 2016 Dec;5(8):512-521. doi: 10.1177/2048872615585517. Epub 2015 May 12.
In recent years, an increasing number of papers have been published on the use of extracorporeal cardiopulmonary resuscitation (ECPR) in adult patients, but, although promising results have been reported in patients with in-hospital refractory cardiac arrest supported by extracorporeal life support (ECLS), data on patients with out-of-hospital (OHCA) cardiac arrest are scarce and conflicting. The present study aims at summarizing the available evidence on the use of ECPR in adult patients with OHCA, clinically focusing on the factors most often associated with outcome in these patients. Even in the absence of randomized trials, there is growing evidence from ECLS centers documenting sound clinical benefits of ECPR in selected OHCA. According to the available evidence, three factors seem to contribute strongly to the favorable outcome of ECLS supported OHCA patients: (a) selection of patients (mainly definition of age range and a witnessed cardiac arrest); (b) the availability of an ECLS team, well skilled and experienced (to reduce time of implantation and incidence of complications); (c) a multifaceted approach to the OHCA patient (the so-called ECLS-bundle) to treat the reversible cause of CA (i.e. percutaneous coronary intervention), ensure neuroprotection (hypothermia), and maintain organ perfusion (till recovery). Taking into account the promising results of ECPR in selected OHCA patients, there is a clinical need for shared protocols to reduce differences related to the center experience and mostly to increase availability of ECLS as part of a multifaceted approach for these patients.
近年来，越来越多的论文发表了关于体外心肺复苏（ECPR）在成年患者中的应用，尽管体外生命支持（ECLS）支持下的院内难治性心脏骤停患者的结果令人鼓舞，但关于院外（OHCA）心脏骤停患者的数据却很少且相互矛盾。本研究旨在总结目前关于 ECPR 在成年 OHCA 患者中的应用的证据，临床重点关注与这些患者预后最相关的因素。即使没有随机试验，来自 ECLS 中心的越来越多的证据也证明了在选定的 OHCA 中 ECPR 的良好临床获益。根据现有证据，有三个因素似乎强烈影响 ECLS 支持的 OHCA 患者的良好预后：（a）患者选择（主要是年龄范围的定义和目击的心脏骤停）；（b）ECLS 团队的可用性，技能熟练且经验丰富（以减少植入时间和并发症的发生率）；（c）对 OHCA 患者采取多方面的方法（所谓的 ECLS 捆绑），以治疗 CA 的可逆原因（即经皮冠状动脉介入治疗），确保神经保护（低温），并维持器官灌注（直到恢复）。考虑到 ECPR 在选定的 OHCA 患者中取得的有希望的结果，临床需要制定共享的方案，以减少与中心经验相关的差异，并主要增加 ECLS 的可用性，作为这些患者多方面方法的一部分。
