University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Department of Emergency Medicine, Grenoble Alpes University Hospital, Grenoble, France.
Adult Intensive Care Unit, Department of Anaesthesiology - SAMU de Paris, Assistance Publique - Hopitaux de Paris, Paris, France; INSERM U970, Unité 4 SDEC, Paris, France.
Resuscitation. 2021 May;162:163-170. doi: 10.1016/j.resuscitation.2021.02.022. Epub 2021 Feb 18.
Prognostication of refractory out-of-hospital cardiac arrest (OHCA) is essential for selecting the population that may benefit from extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to examine the prognostic value of signs of life before or throughout conventional CPR for individuals undergoing ECPR for refractory OHCA.
Pooling the original data from three cohort studies, we estimated the prevalence of signs of life, for individuals with refractory OHCA resuscitated with ECPR. We performed multivariable logistic regression to examine the independent associations between the occurrence of signs of life and 30-day survival with a CPC score ≤ 2.
The analytical sample consisted of 434 ECPR recipients. The prevalence of any sign of life was 61%, including pupillary light reaction (48%), gasping (32%), or increased level of consciousness (13%). Thirty-day survival with favorable neurological outcome was 15% (63/434). In multivariable analysis, the adjusted odds ratios of 30-day survival with favorable neurological outcome were 7.35 (95% confidence interval [CI], 2.71-19.97), 5.86 (95% CI, 2.28-15.06), 4.79 (95% CI, 2.16-10.63), and 1.75 (95% CI, 0.95-3.21) for any sign of life, pupillary light reaction, increased level of consciousness, and gasping, respectively.
The assessment of signs of life before or throughout CPR substantially improves the accuracy of a multivariable prognostic model in predicting 30-day survival with favorable neurological outcome. The lack of any sign of life might obviate the provision of ECPR for patients without shockable cardiac rhythm.
对于难治性院外心脏骤停（OHCA）患者，预后预测对于选择可能从体外心肺复苏（ECPR）中获益的人群至关重要。本研究旨在探讨 ECPR 治疗难治性 OHCA 患者中 CPR 前或整个 CPR 过程中生命迹象对预后的预测价值。
通过对三项队列研究的原始数据进行汇总，我们估计了接受 ECPR 治疗的难治性 OHCA 患者中存在生命迹象的比例。采用多变量逻辑回归分析评估生命迹象的发生与 30 天生存率（CPC 评分≤2）之间的独立关联。
分析样本包括 434 名接受 ECPR 的患者。任何生命迹象的发生率为 61%，包括瞳孔光反应（48%）、喘息（32%）或意识水平增加（13%）。30 天生存率和良好神经结局分别为 15%（63/434）。多变量分析中，30 天生存率和良好神经结局的调整比值比（OR）分别为 7.35（95%可信区间 [CI]，2.71-19.97）、5.86（95% CI，2.28-15.06）、4.79（95% CI，2.16-10.63）和 1.75（95% CI，0.95-3.21），分别对应任何生命迹象、瞳孔光反应、意识水平增加和喘息。
在 CPR 前或整个 CPR 过程中评估生命迹象可显著提高多变量预后模型预测 30 天生存率和良好神经结局的准确性。如果没有任何生命迹象，可能无需对没有可除颤性心律失常的患者提供 ECPR。
