Burke Christopher R, Chan Titus, Brogan Thomas V, McMullan D Michael
Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, United States.
Division of Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, United States.
Resuscitation. 2017 May;114:47-52. doi: 10.1016/j.resuscitation.2017.03.001. Epub 2017 Mar 2.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a lifesaving rescue therapy for patients with refractory cardiac arrest. Previous studies suggest that maintaining a 24/7 in-house surgical team may reduce ECPR initiation time and improve survival in adult patients. However, an association between cardiac arrest occurring during off-hours and ECPR outcome has not been established in children.
This is a single institution, retrospective review of all pediatric patients who received ECPR from December 2008 to August 2015.
During the study period, ECPR was performed 54 times in 53 patients (20 weekday, 34 night/weekend). Interval from ECPR activation to initiation of extracorporeal life support was significantly longer during night/weekends (49min night/weekend vs. 33min weekday, p<0.001) as was the interval from ECPR activation to incision for cannulation (26min night/weekend vs. 14min Weekday, p<0.001). Rate of central nervous system (CNS) injury was higher in the night/weekend group (43% night/weekend vs. 15% weekday, p=0.04), with associated 75% mortality prior to hospital discharge. Time of arrest did not impact survival to hospital discharge (44% night/weekend vs. 55% weekday, p=0.57), one-year survival (33% night/weekend vs. 44% weekday, p=0.44), or neurologic outcome (Pediatric Cerebral Performance Score at 1-year post-ECPR, 1.45 weekday vs. 1.50 night/weekend, p=0.82).
Cardiac arrest occurring at night or during weekend hours is associated with a longer ECPR initiation time and higher rates of CNS injury. However, prolonged pre-ECPR support associated with off-hours cardiac arrest does not appear to impact survival or functional outcome in pediatric patients.
体外心肺复苏（ECPR）是一种用于治疗难治性心脏骤停患者的挽救生命的治疗方法。先前的研究表明，维持一个全天候的院内手术团队可能会缩短ECPR启动时间并提高成年患者的生存率。然而，儿童非工作时间发生的心脏骤停与ECPR结局之间的关联尚未确立。
这是一项对2008年12月至2015年8月期间接受ECPR的所有儿科患者进行的单机构回顾性研究。
在研究期间，53例患者共进行了54次ECPR（20次在工作日，34次在夜间/周末）。夜间/周末从ECPR启动到开始体外生命支持的时间间隔明显更长（夜间/周末为49分钟，工作日为33分钟，p<0.001），从ECPR启动到插管切口的时间间隔也是如此（夜间/周末为26分钟，工作日为14分钟，p<0.001）。夜间/周末组中枢神经系统（CNS）损伤的发生率更高（夜间/周末为43%，工作日为15%，p=0.04），出院前死亡率为75%。心脏骤停时间对出院生存率（夜间/周末为44%，工作日为55%，p=0.57）、一年生存率（夜间/周末为33%，工作日为44%，p=0.44）或神经学结局（ECPR后1年的小儿脑功能评分，工作日为1.45，夜间/周末为1.50，p=0.82）没有影响。
夜间或周末发生的心脏骤停与更长的ECPR启动时间和更高的CNS损伤发生率相关。然而，与非工作时间心脏骤停相关的ECPR前的长时间支持似乎并未影响儿科患者的生存率或功能结局。
