School of Medicine, University of Washington, Seattle, WA, United States.
Harborview Injury Prevention and Research Center, Seattle, WA, United States.
Resuscitation. 2020 Dec;157:225-229. doi: 10.1016/j.resuscitation.2020.09.035. Epub 2020 Oct 12.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging invasive rescue therapy for treatment of refractory out-of-hospital cardiac arrests (OHCA). We aim to describe the incidence of traumatic and hemorrhagic complications among patients undergoing ECPR for OHCA and examine the association between CPR duration and ECPR-related injuries or bleeding.
We examined prospectively collected data from the Extracorporeal Resuscitation Outcomes Database (EROD), which includes ECPR-treated OHCAs from participating hospitals (October 2014 to August 2019). The primary outcome was traumatic or hemorrhagic complications, defined any of the following: pneumothorax, pulmonary hemorrhage, major bleeding, cannula site bleeding, gastrointestinal bleeding, thoracotomy, cardiac tamponade, aortic dissection, or vascular injury during hospitalization. The primary exposure was the cardiac arrest to ECPR initiation interval (CA-ECPR interval), measured as the time from arrest to initiation of ECPR. Descriptive statistics were used to compare demographic, cardiac arrest, and ECPR characteristics among patients with and without CPR-related traumatic or bleeding complications. Multivariable logistic regression was used to examine the association between CA-ECPR interval and traumatic or bleeding complications.
A total of 68 patients from 4 hospitals receiving ECPR for OHCA were entered into EROD and met inclusion criteria. Median age was 51 (interquartile range 38-58), 81% were male, 40% had body mass index > 30, and 70% had pre-existing medical comorbidities. A total of 65% had an initial shockable cardiac rhythm, mechanical CPR was utilized in at least 29% of patients, and 27% were discharged alive. The median time from arrest to ECPR initiation was 73 min (IQR 60-104). A total of 37% experienced a traumatic or bleeding complication, with major bleeding (32%), vascular injury (18%), and cannula site bleeding (15%) being the most common. Compared to patients with shorter CPR times, patients with a longer CA-ECPR interval had 18% (95% confidence interval - 2-42%) higher odds of suffering a mechanical or bleeding complication, but this did not reach statistical significance (p = 0.08).
Traumatic injuries and bleeding complications are common among patients undergoing ECPR. Further study is needed to investigate the relation between arrest duration and complications. Clinicians performing ECPR should anticipate and assess for injuries and bleeding in this high-risk population.
体外心肺复苏（ECPR）是一种新兴的侵入性抢救疗法，用于治疗难治性院外心脏骤停（OHCA）。我们旨在描述接受 ECPR 治疗 OHCA 的患者中创伤性和出血性并发症的发生率，并研究心肺复苏（CPR）持续时间与 ECPR 相关损伤或出血之间的关系。
我们检查了来自参与医院的体外复苏结果数据库（EROD）中前瞻性收集的数据（2014 年 10 月至 2019 年 8 月）。主要结局是创伤性或出血性并发症，定义为以下任何一种情况：气胸、肺出血、大出血、导管部位出血、胃肠道出血、开胸术、心脏压塞、主动脉夹层或血管损伤。主要暴露是心脏骤停至 ECPR 开始时间（CA-ECPR 时间），定义为从心脏骤停到开始 ECPR 的时间。描述性统计用于比较有和无 CPR 相关创伤或出血并发症的患者的人口统计学、心脏骤停和 ECPR 特征。多变量逻辑回归用于检查 CA-ECPR 时间与创伤性或出血性并发症之间的关系。
共有 4 家医院的 68 名接受 OHCA 治疗的患者进入 EROD 并符合纳入标准。中位年龄为 51 岁（四分位距 38-58），81%为男性，40%的体重指数> 30，70%有既往合并症。65%有初始可除颤的心律失常，至少 29%的患者使用机械 CPR，27%出院存活。从心脏骤停到 ECPR 开始的中位时间为 73 分钟（IQR 60-104）。37%的患者发生创伤性或出血性并发症，其中大出血（32%）、血管损伤（18%）和导管部位出血（15%）最常见。与 CPR 时间较短的患者相比，CPR 时间较长的患者机械或出血性并发症的几率高 18%（95%置信区间-2-42%），但无统计学意义（p=0.08）。
接受 ECPR 治疗的患者中常见创伤性损伤和出血性并发症。需要进一步研究以探讨心肺复苏持续时间与并发症之间的关系。进行 ECPR 的临床医生应在这一高危人群中预测和评估损伤和出血。
