Department of Critical Care Medicine, Maoming People's Hospital, 101 Weimin Road, Maoming, 525000, Guangdong, China.
Clinical Research Center, Center of Scientific Research, Maoming People's Hospital, 101 Weimin Road, Maoming, 525000, Guangdong, China.
Eur J Med Res. 2022 May 28;27(1):77. doi: 10.1186/s40001-022-00711-1.
Extracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR), also known as extracorporeal cardiopulmonary resuscitation (ECPR), has shown encouraging results in refractory cardiac arrest (RCA) resuscitation. However, its therapeutic benefits are linked to instant and uninterrupted chest compression (CC), besides early implementation. Mechanical CC can overcome the shortcomings of conventional manual CC, including fatigue and labor consumption, and ensure adequate blood perfusion. A strategy sequentially linking mechanical CPR with ECPR may earn extra favorable outcomes.
We present a four-case series with ages ranging from 8 to 94 years who presented with prolonged absences of return of spontaneous circulation (ROSC) after CA associated with acute fulminant myocarditis (AFM) and myocardial infarction (MI). All the cases received VA-ECMO (ROTAFLOW, Maquet) assisted ECPR, with intra-aortic balloon pump (IABP) or continuous renal replacement treatment (CRRT) appended if persistently low mean blood pressure (MAP) or ischemic kidney injury occurred. All patients have successfully weaned off ECMO and the assistant life support devices with complete neurological recovery. Three patients were discharged, except the 94-year-old patient who died of irreversible sepsis 20 days after ECMO weaning-off. These encouraging results will hopefully lead to more consideration of this lifesaving therapy model that sequentially integrates mechanical CPR with ECPR to rescue RCA related to reversible cardiac causes.
This successful case series should lead to more consideration of an integrated lifesaving strategy sequentially linking mechanical cardiopulmonary resuscitation with ECPR, as an extra favorable prognosis of refractory cardiac arrest related to this approach can be achieved.
体外膜肺氧合（ECMO）支持心肺复苏（CPR），也称为体外心肺复苏（ECPR），在难治性心脏骤停（RCA）复苏中显示出令人鼓舞的结果。然而，其治疗益处与即时和不间断的胸外按压（CC）有关，除了早期实施外。机械 CC 可以克服传统手动 CC 的缺点，包括疲劳和劳力消耗，并确保足够的血液灌注。机械 CPR 与 ECPR 顺序链接的策略可能会获得额外的有利结果。
我们报告了一个四例病例系列，年龄从 8 岁到 94 岁不等，他们在与急性暴发性心肌炎（AFM）和心肌梗死（MI）相关的 CA 后出现自发循环恢复（ROSC）长时间消失。所有病例均接受 VA-ECMO（ROTAFLOW，Maquet）辅助 ECPR，如果持续低血压（MAP）或缺血性肾损伤发生，则附加主动脉内球囊泵（IABP）或连续肾脏替代治疗（CRRT）。所有患者均成功撤机 ECMO 和辅助生命支持设备，完全恢复神经功能。除了 ECMO 撤机后 20 天死于不可逆转败血症的 94 岁患者外，有 3 例患者出院。这些令人鼓舞的结果有望导致更多地考虑这种将机械 CPR 与 ECPR 顺序整合的救生治疗模式，以挽救与可逆性心脏原因相关的 RCA。
这个成功的病例系列应该导致更多地考虑将机械心肺复苏与 ECPR 顺序整合的救生策略，因为这种方法可以实现难治性心脏骤停相关的预后更好。
