Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
Catheter Cardiovasc Interv. 2020 Sep 1;96(3):547-555. doi: 10.1002/ccd.28492. Epub 2019 Sep 5.
The aims of this single-center retrospective study were to characterize and determine predictors of 30-day survival in a cohort of patients requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported cardiopulmonary resuscitation (E-CPR) in the cardiac catheterization laboratory (CCL) for cardiac arrest (CA) or refractory cardiogenic shock (CS).
While safety in the CCL has improved, periprocedural mortality from CA remains high. The application of VA-ECMO is an emerging form of resuscitation with a paucity of data evaluating its use in the CCL for CA or CS.
All consecutive patients aged 18 years or older presenting to a single CCL from October 2010 to May 2018 who required E-CPR for CA or refractory CS were included. The primary outcome of our study was overall survival 30 days from VA-ECMO initiation. Secondary outcomes included 1-year survival, hospital length of stay, and ECMO related complications.
Sixty-two patients with a mean age of 60 ± 9 years, 63% male, were included. VA-ECMO was initiated for CA in 39 patients (63%) and for CS in 23 patients (37%). The median ECMO duration was 48 hr. Overall 30-day survival was 47% (CA group 44% vs. CS group 52%; p = .414). One-year survival was 44%. Initial serum creatinine (OR 1.18 per 10 μmol/L increase; p = .016; AUC = 0.65) was the only multivariate predictor of 30-day mortality.
The use of VA-ECMO in the CCL is feasible, demonstrating 47% 30-day survival, largely persistent to 1 year, in a cohort that otherwise has extremely high mortality.
本单中心回顾性研究的目的在于，分析并确定需要在导管室（CCL）进行心肺复苏（E-CPR）的患者的 30 天生存率及其预测因素，这些患者因心搏骤停（CA）或难治性心源性休克（CS）而接受静脉动脉体外膜肺氧合（VA-ECMO）支持。
虽然 CCL 的安全性有所提高，但 CA 的围手术期死亡率仍然很高。VA-ECMO 的应用是一种新兴的复苏形式，目前关于其在 CA 或 CS 中用于 CCL 的数据很少。
本研究纳入了 2010 年 10 月至 2018 年 5 月期间在单一 CCL 就诊且因 CA 或难治性 CS 而接受 E-CPR 的年龄在 18 岁及以上的所有连续患者。本研究的主要结局是从 VA-ECMO 开始后的 30 天总生存率。次要结局包括 1 年生存率、住院时间和 ECMO 相关并发症。
62 名患者的平均年龄为 60±9 岁，63%为男性。39 名患者（63%）因 CA 而开始 VA-ECMO，23 名患者（37%）因 CS 而开始 VA-ECMO。ECMO 持续时间中位数为 48 小时。总体 30 天生存率为 47%（CA 组为 44%，CS 组为 52%；p=0.414）。1 年生存率为 44%。初始血清肌酐（每增加 10μmol/L，OR 1.18；p=0.016；AUC=0.65）是 30 天死亡率的唯一多变量预测因素。
VA-ECMO 在 CCL 中的应用是可行的，在一组死亡率极高的患者中，30 天生存率为 47%，在很大程度上可持续至 1 年。
