Lee Seok In, Lim Yong Su, Park Chul-Hyun, Choi Woo Sung, Choi Chang Hyu
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea.
Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea.
J Card Surg. 2021 Aug;36(8):2743-2750. doi: 10.1111/jocs.15614. Epub 2021 May 16.
Recent reports have revealed better clinical outcomes for extracorporeal cardiopulmonary resuscitation (ECPR) than conventional cardiopulmonary resuscitation (CPR). In this retrospective study, we attempted to identify predictors associated with successful weaning off extracorporeal membrane oxygenation (ECMO) support after ECPR.
The demographic and clinical data of 30 ECPR patients aged over 18 years treated between August 2016 and January 2019 were analyzed. All clinical data were retrospectively collected. The primary endpoint was successful weaning off ECMO support after ECPR. Patients were divided into two groups based on successful or unsuccessful weaning off ECMO support (Weaned (n = 14) vs. Failed (n = 16)).
Univariate logistic regression analysis showed that age, CPR duration, ECMO complications, and loss of pulse pressure significantly predicted the results of weaning off ECMO support. However, multivariate logistic regression analysis showed that only CPR duration and loss of pulse pressure independently predicted unsuccessful weaning from ECMO support.
We conclude that long CPR duration and loss of pulse pressure after ECPR predict unsuccessful weaning from ECMO. However, unlike CPR duration, loss of pulse pressure during post-ECPR was related to subsequent management. In patients with reduced pulse pressure after ECPR, careful management is warranted because this reduction is closely associated with unsuccessful weaning off ECMO support after ECPR.
近期报告显示，体外心肺复苏（ECPR）的临床效果优于传统心肺复苏（CPR）。在这项回顾性研究中，我们试图确定与ECPR后成功撤掉体外膜肺氧合（ECMO）支持相关的预测因素。
分析了2016年8月至2019年1月期间接受治疗的30例年龄超过18岁的ECPR患者的人口统计学和临床数据。所有临床数据均为回顾性收集。主要终点是ECPR后成功撤掉ECMO支持。根据ECMO支持撤掉成功与否将患者分为两组（撤掉组（n = 14）与未撤掉组（n = 16））。
单因素逻辑回归分析显示，年龄、CPR持续时间、ECMO并发症和脉压消失显著预测了撤掉ECMO支持的结果。然而，多因素逻辑回归分析显示，只有CPR持续时间和脉压消失独立预测了ECMO支持撤掉失败。
我们得出结论，ECPR后CPR持续时间长和脉压消失预示着ECMO撤掉失败。然而，与CPR持续时间不同，ECPR后脉压消失与后续管理有关。在ECPR后脉压降低的患者中，需要谨慎管理，因为这种降低与ECPR后ECMO支持撤掉失败密切相关。
