经导管心脏泵支持的体外心肺复苏（ECPELLA）对难治性心脏骤停患者短期生存及神经功能转归改善的影响——一项单中心回顾性队列研究
Impact of extracorporeal CPR with transcatheter heart pump support (ECPELLA) on improvement of short-term survival and neurological outcome in patients with refractory cardiac arrest - A single-site retrospective cohort study.
作者信息
Unoki Takashi, Kamentani Motoko, Nakayama Tomoko, Tamura Yudai, Konami Yutaka, Suzuyama Hiroto, Inoue Masayuki, Yamamuro Megumi, Taguchi Eiji, Sawamura Tadashi, Nakao Koichi, Sakamoto Tomohiro
机构信息
Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto City, Kumamoto 861-4193, Japan.
出版信息
Resusc Plus. 2022 May 20;10:100244. doi: 10.1016/j.resplu.2022.100244. eCollection 2022 Jun.
AIM
Extracorporeal cardiopulmonary resuscitation (E-CPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest. Although VA-ECMO preserves end-organ perfusion, it may affect left ventricular (LV) recovery due to increased LV load. An emerging treatment modality, ECPELLA, which combines VA-ECMO and a transcatheter heart pump, Impella, can simultaneously provide circulatory support and LV unloading. In this single-site cohort study, we assessed impact of ECPELLA support on clinical outcomes of refractory cardiac arrest patients.
METHOD
We retrospectively reviewed 165 consecutive cardiac arrest patients, who underwent E-CPR by VA-ECMO with or without intra-aortic balloon pump (IABP) or ECPELLA from January 2012 to September 2021. We assessed 30-day survival rate, neurological outcome, hemodynamic data, and safety profiles including hemolysis, acute kidney injury, blood transfusion and embolic cerebral infarction.
RESULTS
Among 165 E-CPR patients, 35 patients were supported by ECPELLA, and 130 patients were supported by conventional VA-ECMO with or without IABP. Following propensity score matching of 30 ECPELLA and 30 VA-ECMO patients, the 30-day survival (ECPELLA: 53%, VA-ECMO: 20%, p < 0.01) and favorable neurological outcome determined by the Cerebral Performance Category score 1 or 2 (ECPELLA: 33%, VA-ECMO: 7%, p < 0.01) were significantly higher with ECPELLA. Patients receiving ECPELLA also showed significantly higher total mechanical circulatory support flow and lower arterial pulse pressure for the first 3 days (p < 0.01) of treatment. There were no statistical differences in safety profiles between treatment groups.
CONCLUSION
ECPELLA may be associated with improved 30-day survival and neurological outcome in patients with refractory cardiac arrest.
目的
使用静脉-动脉体外膜肺氧合（VA-ECMO）的体外心肺复苏（E-CPR）是一种用于难治性心脏骤停的新型救生方法。尽管VA-ECMO可维持终末器官灌注，但由于左心室（LV）负荷增加，它可能会影响左心室恢复。一种新兴的治疗方式，即结合VA-ECMO和经导管心脏泵Impella的ECPELLA，可同时提供循环支持和左心室减负。在这项单中心队列研究中，我们评估了ECPELLA支持对难治性心脏骤停患者临床结局的影响。
方法
我们回顾性分析了2012年1月至2021年9月期间连续接受VA-ECMO进行E-CPR的165例心脏骤停患者，这些患者接受或未接受主动脉内球囊泵（IABP）或ECPELLA治疗。我们评估了30天生存率、神经功能结局、血流动力学数据以及包括溶血、急性肾损伤、输血和栓塞性脑梗死在内的安全性指标。
结果
在165例接受E-CPR的患者中，35例接受了ECPELLA支持，130例接受了常规VA-ECMO（伴或不伴IABP）支持。在对30例ECPELLA患者和30例VA-ECMO患者进行倾向评分匹配后，ECPELLA组的30天生存率（ECPELLA：53%，VA-ECMO：20%，p<0.01）和由脑功能分类评分1或2确定的良好神经功能结局（ECPELLA：33%，VA-ECMO：7%，p<0.01）显著更高。接受ECPELLA治疗的患者在治疗的前3天还表现出总机械循环支持流量显著更高且动脉脉压更低（p<0.01）。治疗组之间在安全性指标方面无统计学差异。
结论
ECPELLA可能与难治性心脏骤停患者30天生存率和神经功能结局的改善相关。
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