Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Department of Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Scand J Trauma Resusc Emerg Med. 2020 Jun 23;28(1):58. doi: 10.1186/s13049-020-00753-6.
Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution.
This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model.
The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups.
Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
常规心肺复苏（C-CPR）无效的难治性心脏骤停预后较差。尽管先前的报告表明体外心肺复苏（E-CPR）可以改善临床预后，但在实施 E-CPR 之前，没有可用于预测患者预后的临床适用预测因子。我们旨在评估难治性心脏骤停患者接受 E-CPR 时的临床因素，以预测本机构患者的预后。
这是一项单中心回顾性研究。我们报告了 2012 年 1 月至 2017 年 11 月期间因 C-CPR 无效而接受难治性心脏骤停的 112 例患者。当推测心源性病因时，所有患者均接受 E-CPR 以继续进行生命支持。分析与患者预后相关的临床因素。提取与 ECMO 前显著相关的临床因素，以建立患者预后风险预测模型。
出院时的总生存率为 40.2%，出院时神经功能良好的患者为 30.4%。出院后 6 个月的生存率为 36.6%，出院后 6 个月时神经功能良好的患者为 25.9%。根据我们从 ECMO 前临床参数中得出的 TLR 评分（低流量时间、心脏骤停位置和初始心脏骤停节律），我们将患者分为低危组（n=38）、中危组（n=47）和高危组（n=27）。与中危组和高危组相比，低危组出院时的生存率更高（65.8% vs. 42.6% vs. 0%，p<0.0001），6 个月时的生存率也更高（60.5% vs. 38.3% vs. 0%，p=0.0001）。低危组出院时的神经功能预后也更好（50% vs. 31.9% vs. 0%，p=0.0001），6 个月后也更好（44.7% vs. 25.5% vs. 0%，p=0.0003）。
接受 E-CPR 的难治性心脏骤停患者可通过 ECMO 前的临床因素进行分层，以预测临床预后。需要更大规模的研究来验证我们的观察结果。
