Darocha Tomasz, Kosiński Sylweriusz, Jarosz Anna, Sobczyk Dorota, Gałązkowski Robert, Piątek Jacek, Konstany-Kalandyk Janusz, Drwiła Rafał
Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
Polish Medical Air Rescue, Warsaw, Poland.
Scand J Trauma Resusc Emerg Med. 2016 Jun 29;24:85. doi: 10.1186/s13049-016-0281-9.
The prognosis in hypothermic cardiac arrest is frequently good despite prolonged period of hypoperfusion and cardiopulmonary resuscitation. Apart from protective effect of hypothermia itself established protocols of treatment and novel rewarming techniques may influence on outcome. The purpose of the study was to assess the outcome of patients with hypothermic circulatory arrest treated by means of arterio-venous extracorporeal membrane oxygenation (ECMO) according to locally elaborated protocol in Severe Accidental Hypothermia Center in Cracow, Poland.
Prospective observational case-series study - all patients with confirmed hypothermic cardiac arrest consulted with hypothermia coordinator were accepted for extracorporeal rewarming, unless contraindications for ECMO were observed (active bleeding).
The study population consisted of 10 patients (7 male, median age 48.5 years). The core temperature measured esophageally was 16.9-28.4 °C, median 22 °C. On admission 5 patients presented with asystole and 5 with ventricular fibrillation. Duration of circulatory arrest before ECMO implantation was 107 to 345 min (median 156 min). The duration of ECMO support was 1.5 to 91 h (median 22 h). Cardiorespiratory stability and full neurologic recovery was achieved in 7 patients. The duration of mechanical ventilation was 88-437 h (median 177 h) and the length of stay in the ICU was 8-26 days (median 15 days). All survivors had mildly impaired (1 patient, LVEF 40 %) or preserved (6 patients, LVEF 55-65 %) left ventricular systolic function at the time of discharge from ICU. The cause of death of non-survivors (three patients) was acute myocarditis, massive retroperitoneal bleeding, and massive gastrointestinal bleeding.
Our data confirm the high survival rate (70 %) and excellent neurologic outcome in hypothermic cardiac arrest. The following key elements seem to impact the final prognosis: the appropriate coordination of the rescue operation, immediate high-quality CPR (preferably using mechanical chest compression system) and application of ECMO for rewarming and cardiorespiratory support.
尽管低温性心脏骤停患者存在长时间的低灌注和心肺复苏情况，但其预后通常良好。除了低温本身的保护作用外，既定的治疗方案和新型复温技术可能会影响治疗结果。本研究的目的是评估在波兰克拉科夫严重意外低温中心，根据当地制定的方案，采用动静脉体外膜肺氧合（ECMO）治疗低温循环骤停患者的治疗结果。
前瞻性观察性病例系列研究——所有确诊为低温性心脏骤停并咨询低温协调员的患者，除非观察到有ECMO的禁忌证（活动性出血），均接受体外复温治疗。
研究人群包括10例患者（7例男性，中位年龄48.5岁）。经食管测量的核心温度为16.9 - 28.4℃，中位温度为22℃。入院时，5例患者表现为心搏停止，5例患者表现为心室颤动。植入ECMO前循环骤停的持续时间为107至345分钟（中位时间156分钟）。ECMO支持的持续时间为1.5至91小时（中位时间22小时）。7例患者实现了心肺稳定和完全神经功能恢复。机械通气的持续时间为88 - 437小时（中位时间177小时），在重症监护病房的住院时间为8 - 26天（中位时间15天）。所有幸存者在从重症监护病房出院时，左心室收缩功能轻度受损（1例患者，左心室射血分数40%）或保留（6例患者，左心室射血分数55 - 65%）。非幸存者（3例患者）的死亡原因是急性心肌炎、大量腹膜后出血和大量胃肠道出血。
我们的数据证实了低温性心脏骤停患者的高生存率（70%）和良好的神经功能预后。以下关键因素似乎会影响最终预后：救援行动的适当协调、立即进行高质量的心肺复苏（最好使用机械胸外按压系统）以及应用ECMO进行复温和心肺支持。
