Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver General Hospital, Rm 330, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada.
Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, V6T 1Z3 Vancouver, British Columbia, Canada.
J Crit Care. 2018 Apr;44:31-38. doi: 10.1016/j.jcrc.2017.10.011. Epub 2017 Oct 12.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO.
A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1-2).
There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition.
The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.
静脉-动脉体外膜肺氧合（VA-ECMO）可能对难治性心搏骤停和心源性休克患者有益。我们旨在总结我们中心在复苏性 VA-ECMO 方面的 6 年经验。
对因难治性院内（IHCA）/院外（OHCA）心搏骤停（E-CPR）或难治性心源性休克（E-CS）而接受 VA-ECMO 治疗的非心脏手术患者进行回顾性病历审查（2009 年 4 月至 2015 年），包括有或无先前心脏骤停的患者。我们的主要结局是存活至出院和良好的神经功能状态（Cerebral Performance Category 1-2）。
共有 22 名患者符合纳入标准，其中 9 名接受 E-CPR（8 名 IHCA，1 名 OHCA），13 名接受 E-CS。E-CPR 患者的中位年龄为 52 [IQR 45，58] 岁，E-CS 患者为 54 [IQR 38，64] 岁。E-CPR 患者的心脏骤停持续时间为 70.33（SD 39.56）分钟，而 9 名先前接受 E-CS 治疗的患者为 24.67（SD 26.73）分钟。初始心脏骤停节律为无脉性电活动（39%）、心室颤动（33%）或室性心动过速（28%）。共有 22 例患者中的 18 例（78%）成功脱离 VA-ECMO；16 例患者存活至出院（73%），15 例患者神经功能良好。
我们中心开始使用 VA-ECMO 治疗难治性心脏骤停和心源性休克，产生了较高比例的存活者和良好的神经功能结局。
