Ellouze Omar, Vuillet Melitine, Perrot Justine, Grosjean Sandrine, Missaoui Anis, Aho Serge, Malapert Ghislain, Bouhemad Belaid, Bouchot Oliver, Girard Claude
Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France.
Service d'Epidémiologie et d'Hygiène Hospitalières, CHU de Dijon, Dijon, France.
Artif Organs. 2018 Jan;42(1):15-21. doi: 10.1111/aor.12992. Epub 2017 Sep 6.
Extracorporeal life support (ECLS) has shown benefits in the management of refractory in-hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS.
体外生命支持（ECLS）已显示出通过提高生存率，在难治性院内心脏骤停（IHCA）管理中具有益处。尽管如此，关于院外难治性心脏骤停（OHCA）的结果仍不确定。我们研究的目的是比较两组之间的生存率。我们对2011年至2015年间接受ECLS治疗的所有IHCA或OHCA患者进行了一项单中心回顾性观察研究。进行多变量分析以确定与死亡率相关的独立因素。在这4年期间，共纳入65例患者，IHCA组43例（66.2%），OHCA组22例（33.8%）。OHCA组的低流量持续时间明显更长（60分钟对90分钟，P = 0.004）。两组的出院生存率相同（OHCA组为27%，IHCA组为23%，P = 0.77）。OHCA组所有存活患者的脑功能分类评分为1 - 2分。在多变量分析中，我们发现初始乳酸水平和基线血肌酐与死亡率独立相关。我们发现在接受ECLS治疗的IHCA和OHCA患者中，生存率和神经学评分相当。我们认为，对患者进行适当选择以及在复苏过程中优化器官灌注，可使接受ECLS治疗的OHCA患者取得良好效果。
