Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Am J Emerg Med. 2018 Apr;36(4):637-640. doi: 10.1016/j.ajem.2017.09.057. Epub 2017 Sep 29.
Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole.
The aim of this study was to investigate the outcome of 3 patient groups separated by initial rhythm at time of ECMO placement during CPR: asystole, PEA and shockable rhythm.
We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and January 2017. Outcome and survival were identified in 3 groups of patients regarding to the heart rhythm at the time decision for ECMO support was made: 1. patients with asystole, 2. patients with pulseless electrical activity, 3. patients with a shockable rhythm.
63 patients underwent ECPR in the mentioned time frame. Five patients were excluded due to incomplete data. Under the 58 included patients the number of cases for asystole, PEA, shockable rhythm was 7, 21 and 30 respectively. The means of CPR-time in these groups were 37, 41 and 37min. Survival to discharge was 0.0%, 23.8% and 40.0% respectively (p=0.09). All survivors to discharge had a good neurological outcome, defined as cerebral performance category 1or 2.
Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR.
心肺复苏联合体外膜肺氧合（ECPR）支持已被证明可提高复苏后心搏骤停患者的预后。目前大多数 ECPR 推荐不包括非除颤性节律（如电机械分离和心搏停止）的患者。
本研究旨在探讨在心肺复苏期间通过初始节律将 3 组患者分组接受 ECMO 治疗的结果：心搏停止、电机械分离和可除颤节律。
我们对 2008 年 6 月至 2017 年 1 月期间在院内发生心搏骤停并接受 ECPR 的成人进行了回顾性单中心研究。根据决定进行 ECMO 支持时的心律，将患者分为 3 组：1. 心搏停止患者；2. 电机械分离患者；3. 可除颤节律患者。识别患者的预后和生存情况。
在上述时间段内，共有 63 例患者接受了 ECPR。由于数据不完整，排除了 5 例患者。在 58 例纳入患者中，心搏停止、电机械分离和可除颤节律的病例数分别为 7、21 和 30。这些组的 CPR 时间均值分别为 37、41 和 37 分钟。出院存活率分别为 0.0%、23.8%和 40.0%（p=0.09）。所有出院存活患者的神经功能预后良好，定义为脑功能表现分类 1 或 2。
在决定进行 ECPR 时初始节律为电机械分离的患者出院存活率为 23.8%，而初始节律为心搏停止的患者无一例出院存活。应慎重考虑对电机械分离患者进行 ECPR。
