Shinar Zachary, Plantmason Lee, Reynolds Joshua, Dembitsky Walter, Bellezzo Joseph, Ho Christopher, Glaser Dale, Adamson Robert
Department of Emergency Medicine, Sharp Memorial Hospital, San Diego, California.
Department of Emergency Medicine, Michigan State University, Grand Rapids, Michigan.
J Emerg Med. 2019 Jun;56(6):666-673. doi: 10.1016/j.jemermed.2019.02.004. Epub 2019 Apr 25.
Extracorporeal membrane oxygenation (ECMO) has several applications as a resuscitative intervention, including extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is rarely initiated in the emergency department (ED) by emergency physicians outside regional academic institutions.
To evaluate whether ECPR improves clinical outcomes after cardiac arrest when initiated by emergency physicians (EPs) in a nonacademic hospital.
We performed a retrospective analysis of prospectively identified consecutive EP-initiated ECMO subjects from a single community hospital over a 7-year period. Logistic regression and propensity models tested the association between ECPR and survival to hospital discharge compared with concurrent ECPR-eligible control subjects.
Over 7 years (2010-2017), EPs initiated ECMO on 58 subjects; 44 (76%) were venoarterial cases (43 ECPR) initiated in the ED. Of those, 11 (25%) survived to discharge (n = 9 with cerebral performance category score 1) and most were still alive after 5 years (66%). Adjusting for known covariates, ECPR subjects were more likely than concurrent controls to survive to discharge (odds ratio 8.4; 95% confidence interval 1.2-60.4). Propensity analysis revealed a favorable trend toward survival to discharge after ECPR (odds ratio 2.0; 95% confidence interval 0.51-7.8).
Emergency physicians initiated ECMO with promising clinical outcomes. Prospective trials are needed to define the efficacy, safety, and cost-effectiveness of EP-initiated ECMO.
体外膜肺氧合（ECMO）作为一种复苏干预措施有多种应用，包括体外心肺复苏（ECPR）。在区域学术机构以外，急诊科（ED）的急诊医生很少启动ECPR。
评估在非学术医院由急诊医生（EPs）启动ECPR时，其是否能改善心脏骤停后的临床结局。
我们对一家社区医院7年间前瞻性确定的连续由急诊医生启动ECMO的患者进行了回顾性分析。与同期符合ECPR条件的对照患者相比，采用逻辑回归和倾向模型测试ECPR与出院存活之间的关联。
在7年（2010 - 2017年）期间，急诊医生对58名患者启动了ECMO；44例（76%）为在急诊科启动的静脉 - 动脉模式病例（43例ECPR）。其中，11例（25%）存活出院（9例脑功能分类评分为1），大多数在5年后仍存活（66%）。在对已知协变量进行调整后，与同期对照相比，接受ECPR的患者出院存活的可能性更大（优势比8.4；95%置信区间1.2 - 60.4）。倾向分析显示ECPR后出院存活有良好趋势（优势比2.0；95%置信区间0.51 - 7.8）。
急诊医生启动ECMO取得了有前景的临床结局。需要进行前瞻性试验来确定急诊医生启动ECMO的疗效、安全性和成本效益。
