Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Sci Rep. 2020 Dec 17;10(1):22180. doi: 10.1038/s41598-020-79283-1.
Precise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.
体外心肺复苏（ECPR）的精确标准在院外心脏骤停（OHCA）患者中仍然缺乏。我们旨在研究采用我们假设的 ECPR 标准治疗难治性 OHCA 患者是否有益。这项前后对照研究比较了符合我们标准的难治性 OHCA 患者实施 ECPR 后的 4.5 年（2015 年 1 月至 2019 年 5 月）与在 ECPR 前 4 年接受常规心肺复苏（CCPR）符合标准的患者（2011 年 1 月至 2014 年 1 月）在急诊科的情况。主要和次要结局分别为 6 个月和 1 个月时的良好神经功能结局，定义为 1 或 2 分的脑功能分类评分。共纳入 70 例患者（40 例接受 CCPR，30 例接受 ECPR）。在 6 个月和 1 个月时，接受 ECPR 的患者（33.3%，26.7%）的神经功能良好状态优于接受 CCPR 的患者（5.0%，5.0%）（均 P < 0.05）。在接受 ECPR 的患者中，神经功能良好的一组患者的低流量时间更短、体外膜氧合时间和住院时间更长，且使用的肾上腺素剂量更低（均 P < 0.05）。在开始 ECPR 前应用详细的适应证似乎可以提高良好神经功能结局的发生率。
