Department of Cardiothoracic Surgery, 9202University Medical Center Regensburg, Regensburg, Germany.
Department of Cardiovascular Surgery, 39070University Medical Center Freiburg, Freiburg, Germany.
Perfusion. 2023 Mar;38(2):436-439. doi: 10.1177/02676591221141325. Epub 2022 Nov 23.
There is increasing evidence for extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue therapy for selected patients in refractory cardiac arrest (CA). Besides patient selection, the control of reperfusion parameters is of eminent importance. Especially in out-of-hospital CA, monitoring and individualized, targeted reperfusion remains a great challenge for emergency personnel. The CARL® system is designed to enable an early control of a variety of reperfusion parameters and to pursue a targeted reperfusion strategy in ECPR.
We report the first 10 ECPR applications of the CARL® system in Regensburg, Germany. Early blood gas analysis, oxygen titration and pressure monitoring were feasible and enabled an individualized and targeted reperfusion strategy in all patients. After suffering from refractory CA and prolonged resuscitation attempts, five out of the first 10 patients survived and were successfully discharged from the hospital (CPC one on hospital discharge).
Application of the CARL® system contributed to early monitoring and control of reperfusion parameters. Whether targeted ECPR may have the potential to improve outcomes in refractory OHCA remains the subject of future investigations.
越来越多的证据表明，体外心肺复苏（ECPR）是治疗难治性心脏骤停（CA）患者的一种抢救疗法。除了患者选择外，再灌注参数的控制也非常重要。特别是在院外 CA 中，监测和个体化、靶向再灌注对急救人员来说仍是一个巨大的挑战。CARL®系统旨在实现多种再灌注参数的早期控制，并在 ECPR 中追求靶向再灌注策略。
我们报告了德国雷根斯堡首次应用 CARL®系统进行的 10 例 ECPR。早期血气分析、氧滴定和压力监测是可行的，并使所有患者能够实现个体化和靶向再灌注策略。在经历了难治性 CA 和长时间的复苏尝试后，首批 10 名患者中有 5 名存活并成功出院（出院时 CPC 为 1 级）。
CARL®系统的应用有助于早期监测和控制再灌注参数。靶向 ECPR 是否有可能改善难治性 OHCA 的预后，仍有待未来研究。
