Wang Junhong, Ma Qingbian, Zhang Hua, Liu Shaoyu, Zheng Yaan
Emergency Department, Peking University Third Hospital.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
Medicine (Baltimore). 2018 Nov;97(48):e13257. doi: 10.1097/MD.0000000000013257.
This systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection.
Electronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome. The literature was screened according to inclusion and exclusion criteria, the baseline information and interested outcomes were extracted. Two reviewers assessed the methodologic quality of the included studies and the quality of evidence for summary estimates independently. Pooled mean difference (MD) or odds ratio (OR) and 95% confidence interval (CI) were calculated by Review Manager Software 5.3. At last the quality of evidence for summary estimates was appraised according to Grading of Recommendations Assessment, Development, and Evaluation rating system.
In 16 studies, 1162 patients were enrolled. Out-of-hospital cardiac arrest (CA) (OR 0.58, 95% CI 0.36-0.93, P = .02), in-hospital CA (OR 1.73, 95% CI 1.08-2.77, P = .02), witnessed CA (OR 5.2, 95% CI 1.18-22.88, P = .01), bystander cardiopulmonary resuscitation (CPR) (OR 7.35, 95% CI 2.32-23.25, P < .01), initial shockable rhythm (OR 2.29, 95% CI 1.53-3.42, P < .01), 1st recorded nonshockable rhythm (OR 0.44, 95% CI 0.29-0.66, P < .01), CPR duration (MD -13.84 minutes, 95% CI -21 to -6.69, P < .0001), arrest-to-extracorporeal membrane oxygenation (ECMO) (MD -17.88 minutes, 95% CI -23.59 to -12.17, P < .01), PH (MD 0.14, 95% CI 0.08-0.21, P < .01), lactate (MD -3.66 mmol/L, 95% CI -7.15 to -0.17, P = .04), and percutaneous coronary intervention (PCI) (OR 1.63, 95% CI 1.02-2.58, P = .04)were identified as the survival predictors of ECPR. Shockable rhythm (OR 2.33, 95% CI 1.20-4.52, P = .01) and CPR duration (MD -9.85 minutes, 95% CI -15.71 to -3.99, P = .001) were identified as the neurologic outcome predictors of ECPR.
Current evidence showed that in-hospital CA, witnessed CA, bystander CPR, initial shockable rhythm, shorter CPR duration and arrest-to-ECMO duration, higher baseline PH, lower baseline lactate and PCI were favourable survival predictors of adult ECPR, and shockable rhythm and shorter CPR duration were good neurological outcome predictors of adult ECPR.
本系统评价旨在探讨成人体外心肺复苏（ECPR）出院及神经功能转归的预测因素，为患者选择提供参考。
通过电子检索PubMed、Embase、Cochrane图书馆，并进行手工检索，查找2000年1月至2018年1月发表的关于成人ECPR预测因素的临床试验，纳入出院及神经功能转归的预测因素。根据纳入和排除标准筛选文献，提取基线信息和感兴趣的结局。两名研究者独立评估纳入研究的方法学质量及汇总估计的证据质量。采用Review Manager软件5.3计算合并均差（MD）或比值比（OR）及95%置信区间（CI）。最后根据推荐意见分级评估、制定与评价（GRADE）评级系统对汇总估计的证据质量进行评价。
16项研究共纳入1162例患者。院外心脏骤停（CA）（OR 0.58，95%CI 0.36 - 0.93，P = 0.02）、院内CA（OR 1.73，95%CI 1.08 - 2.77，P = 0.02）、目击CA（OR 5.2，95%CI 1.18 - 22.88，P = 0.01）、旁观者心肺复苏（CPR）（OR 7.35，95%CI 2.32 - 23.25，P < 0.01）、初始可电击心律（OR 2.29，95%CI 1.53 - 3.42，P < 0.01）、首次记录的不可电击心律（OR 0.44，95%CI 0.29 - 0.66，P < 0.01）、CPR持续时间（MD -13.84分钟，95%CI -21至-6.69，P < 0.0001）、心脏骤停至体外膜肺氧合（ECMO）时间（MD -17.88分钟，95%CI -23.59至-12.17，P < 0.01）、pH值（MD 0.14，95%CI 0.08 - 0.21，P < 0.01）、乳酸（MD -3.66 mmol/L，95%CI -7.15至-0.17，P = 0.04）及经皮冠状动脉介入治疗（PCI）（OR 1.63，95%CI 1.02 - 2.58，P = 0.04）被确定为ECPR生存的预测因素。可电击心律（OR 2.33，95%CI 1.20 - 4.52，P = 0.01）及CPR持续时间（MD -9.85分钟，95%CI -15.71至-3.99，P = 0.001）被确定为ECPR神经功能转归的预测因素。
目前证据表明，院内CA、目击CA、旁观者CPR、初始可电击心律、较短的CPR持续时间及心脏骤停至ECMO时间、较高的基线pH值、较低的基线乳酸水平及PCI是成人ECPR生存的有利预测因素，可电击心律及较短的CPR持续时间是成人ECPR良好神经功能转归的预测因素。
