Yoo Byeong A, Yoo Seungmo, Choi Eun Seok, Kwon Bo Sang, Park Chun Soo, Yun Tae-Jin, Kim Dong-Hee
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Chest Surg. 2023 May 5;56(3):162-170. doi: 10.5090/jcs.22.138. Epub 2023 Apr 5.
Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants.
A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021.
The median age and body weight was 51 days (interquartile range [IQR], 17-111 days) and 3.4 kg (IQR, 2.9-5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61-103 minutes) and duration of ECLS was 7 days (IQR, 3-12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant.
If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.
当复苏失败时，体外心肺复苏（E-CPR）发挥着不可或缺的作用；然而，婴儿的体外生命支持（ECLS）与成人不同。本研究的目的是评估婴儿E-CPR的结果。
进行了一项单中心回顾性研究，分析了2010年至2021年间51例因院内心脏骤停接受E-CPR的连续患者（年龄<1岁）。
中位年龄和体重分别为51天（四分位间距[IQR]，17 - 111天）和3.4 kg（IQR，2.9 - 5.1 kg）。45例患者（88.2%）的心脏骤停原因是心源性的，48例患者（94.1%）有先天性心脏异常。开始ECLS前常规心肺复苏（C-CPR）的中位时间为77分钟（IQR，61 - 103分钟），ECLS持续时间为7天（IQR，3 - 12天）。有36例院内死亡（70.6%），另1例患者在心脏移植后存活。在多变量分析中，单心室生理状态（比值比[OR]，5.05；p = 0.048）、胸骨开放状态（OR，8.69；p = 0.013）和C-CPR时间（每10分钟OR，1.47；p = 0.021）是院内死亡率的显著预测因素。在受试者工作特征曲线中，C-CPR时间的最佳截断值为70.5分钟。早期E-CPR（C-CPR时间<70.5分钟）亚组的院内死亡率有降低趋势（54.5%对82.8%，p = 0.060），尽管无统计学意义。
如果婴儿复苏失败，E-CPR可能是一种挽救生命的选择。提高C-CPR质量并缩短开始ECLS前的时间至关重要。
