Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Crit Care Med. 2019 Apr;47(4):e278-e285. doi: 10.1097/CCM.0000000000003622.
The aim of this study was to determine cardiac arrest- and extracorporeal membrane oxygenation-related risk factors associated with unfavorable outcomes after extracorporeal cardiopulmonary resuscitation.
We performed an analysis of merged data from the Extracorporeal Life Support Organization and the American Heart Association Get With the Guidelines-Resuscitation registries.
A total of 32 hospitals reporting to both registries between 2000 and 2014.
Children younger than 18 years old who suffered in-hospital cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation.
None.
Of the 593 children included in the final cohort, 240 (40.5%) died prior to decannulation from extracorporeal membrane oxygenation and 352 (59.4%) died prior to hospital discharge. A noncardiac diagnosis and preexisting renal insufficiency were associated with increased odds of death (adjusted odds ratio, 1.85 [95% CI, 1.19-2.89] and 4.74 [95% CI, 2.06-10.9], respectively). The median time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was 48 minutes (interquartile range, 28-70 min). Longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was associated with higher odds of death prior to hospital discharge (adjusted odds ratio for each 5 additional minutes of cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation initiation, 1.04 [95% CI, 1.01-1.07]). Each individual adverse event documented during the extracorporeal membrane oxygenation course, including neurologic, pulmonary, renal, metabolic, cardiovascular and hemorrhagic, was associated with higher odds of death, with higher odds as the cumulative number of documented adverse events during the extracorporeal membrane oxygenation course increased.
Outcomes after extracorporeal cardiopulmonary resuscitation reported by linking two national registries are encouraging. Noncardiac diagnoses, preexisting renal insufficiency, longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation, and adverse events during the extracorporeal membrane oxygenation course are associated with worse outcomes.
本研究旨在确定与体外心肺复苏后不良结局相关的心脏骤停和体外膜氧合相关危险因素。
我们对 2000 年至 2014 年间同时向两个注册处报告的体外生命支持组织和美国心脏协会 Get With the Guidelines-Resuscitation 注册处的数据进行了合并分析。
共有 32 家医院参与了该研究。
在院内心脏骤停并接受体外心肺复苏的年龄小于 18 岁的儿童。
无。
在最终纳入的 593 名患儿中，240 名（40.5%）在体外膜氧合脱机前死亡，352 名（59.4%）在出院前死亡。非心脏诊断和预先存在的肾功能不全与死亡风险增加相关（调整后的优势比分别为 1.85（95%CI，1.19-2.89）和 4.74（95%CI，2.06-10.9））。心肺复苏事件开始到体外膜氧合开始的中位时间为 48 分钟（四分位距，28-70 分钟）。心肺复苏事件开始到体外膜氧合开始的时间越长，出院前死亡的风险越高（每增加 5 分钟心肺复苏开始到体外膜氧合开始的时间，调整后的优势比为 1.04（95%CI，1.01-1.07））。体外膜氧合过程中记录的每一个不良事件，包括神经、肺、肾、代谢、心血管和出血，都与死亡风险增加相关，随着体外膜氧合过程中记录的不良事件数量增加，死亡风险也随之增加。
通过链接两个国家注册中心报告的体外心肺复苏后结果令人鼓舞。非心脏诊断、预先存在的肾功能不全、心肺复苏事件开始到体外膜氧合开始的时间延长以及体外膜氧合过程中的不良事件与不良预后相关。
