Asklepios Klinik St Georg, Dept. of Cardiology, Hamburg, Germany.
Asklepios Klinik St Georg, Dept. of Cardiology, Hamburg, Germany.
Resuscitation. 2018 Jun;127:73-78. doi: 10.1016/j.resuscitation.2018.03.036. Epub 2018 Apr 4.
Recent data identifies extracorporeal cardio-pulmonary resuscitation (eCPR) as a potential addendum of conventional cardiopulmonary-resuscitation (cCPR) in highly specified circumstances and selected patients. However, consented criteria indicating eCPR are lacking. Therefore we provide first insights into the health-related quality of life (HRQoL) outcomes of patients treated with eCPR in a real world setting.
Retrospective single-center experience of 60 consecutive patients treated with eCPR between 01/2014 and 06/2016 providing 1-year survival- and HRQoL data obtained through the Short-Form 36 Survey (SF-36) after refractory out-of-hospital- (OHCA) and in-hospital cardiac arrest (IHCA) of presumed cardiac etiology.
Resuscitation efforts until initiation of eCPR averaged 66 ± 35 min and 63.3% of the patients suffered from OHCA. Fifty-five (91.7%) of the overall events were witnessed and bystander-CPR was performed in 73.3% (n = 44) of cases. Cause of arrest was dominated by acute myocardial infarction (AMI, 66.7%) and initial rhythm slightly outbalanced by ventricular fibrillation/tachycardia (VF/VT 53.3%). 12-month survival was 31%. Survivors experienced more often bystander-CPR (p = .001) and a shorter duration of cCPR (p = .002). While mid-term survivors' perceived HRQoL was compromised compared to controls (p ≦ .0001 for PF, RP, RE and BP; p = .007 for GH; p = .016 for SF; p = .030 for MH; p = .108 for VT), scores however resembled HRQoL of subjects on hemodialysis, following cardiogenic shock or pulmonary failure treated with extracorporeal membrane oxygenation (ECMO).
While HRQoL scores of our survivors ranged markedly below controls, compared to patients on chronic hemodialysis, following ECMO for cardiogenic shock or pulmonary failure most of the discrepancies ameliorated. Thus, successfull eCPR in properly selected patients does translate into an encouraging HRQoL approximating chronic renal failure.
最近的数据表明，体外心肺复苏（eCPR）在特定情况下和特定患者中是传统心肺复苏（cCPR）的潜在补充手段。然而，目前还没有关于同意实施 eCPR 的标准。因此，我们首先在真实环境中研究了接受 eCPR 治疗的患者的健康相关生活质量（HRQoL）结局。
回顾性分析 2014 年 1 月至 2016 年 6 月期间在我们中心接受 eCPR 治疗的 60 例连续患者，这些患者因院外（OHCA）和院内心脏骤停（IHCA）且病因推测为心脏原因而接受治疗，通过短格式 36 项调查（SF-36）获得 1 年生存率和 HRQoL 数据。
开始进行 eCPR 之前的复苏时间平均为 66±35 分钟，63.3%的患者发生 OHCA。55（91.7%）例总体事件有目击者，73.3%（n=44）的患者接受了旁观者心肺复苏。停搏的原因主要是急性心肌梗死（AMI，66.7%），初始节律稍偏向于室颤/心动过速（VF/VT，53.3%）。12 个月的生存率为 31%。幸存者更常接受旁观者心肺复苏（p=0.001），cCPR 持续时间更短（p=0.002）。虽然中期幸存者的 HRQoL 较对照组受损（PF、RP、RE 和 BP 评分 p≤0.0001；GH 评分 p=0.007；SF 评分 p=0.016；MH 评分 p=0.030；VT 评分 p=0.108），但与接受体外膜氧合（ECMO）治疗的心源性休克或肺衰竭的慢性血液透析患者的 HRQoL 评分相似。
虽然我们的幸存者的 HRQoL 评分明显低于对照组，但与接受 ECMO 治疗心源性休克或肺衰竭的慢性血液透析患者相比，大多数差异都有所改善。因此，在适当选择的患者中成功实施 eCPR 可带来令人鼓舞的 HRQoL，接近慢性肾衰竭。
