Jeung Kyung Woon, Jung Yong Hun, Gumucio Jorge Antonio, Salcido David D, Menegazzi James J
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea.
Clin Exp Emerg Med. 2023 Sep;10(3):265-279. doi: 10.15441/ceem.23.063. Epub 2023 Jul 13.
The application of venoarterial extracorporeal membrane oxygenation (ECMO) in patients unresponsive to conventional cardiopulmonary resuscitation (CPR) has significantly increased in recent years. To date, three published randomized trials have investigated the use of extracorporeal CPR (ECPR) in adults with refractory out-of-hospital cardiac arrest. Although these trials reported inconsistent results, they suggest that ECPR may have a significant survival benefit over conventional CPR in selected patients only when performed with strict protocol adherence in experienced emergency medical services-hospital systems. Several studies suggest that identifying suitable ECPR candidates and reducing the time from cardiac arrest to ECMO initiation are key to successful outcomes. Prehospital ECPR or the rendezvous approach may allow more patients to receive ECPR within acceptable timeframes than ECPR initiation on arrival at a capable hospital. ECPR is only one part of the system of care for resuscitation of cardiac arrest victims. Optimizing the chain of survival is critical to improving outcomes of patients receiving ECPR. Further studies are needed to find the optimal strategy for the use of ECPR.
近年来，静脉-动脉体外膜肺氧合（ECMO）在对传统心肺复苏（CPR）无反应的患者中的应用显著增加。迄今为止，三项已发表的随机试验研究了体外心肺复苏（ECPR）在成人院外难治性心脏骤停中的应用。尽管这些试验报告的结果不一致，但它们表明，仅在经验丰富的紧急医疗服务-医院系统中严格遵循方案实施时，ECPR在特定患者中可能比传统CPR具有显著的生存获益。几项研究表明，识别合适的ECPR候选者并缩短从心脏骤停到启动ECMO的时间是成功治疗的关键。与在有能力的医院到达时启动ECPR相比，院前ECPR或会合方法可能使更多患者在可接受的时间范围内接受ECPR。ECPR只是心脏骤停受害者复苏护理系统的一部分。优化生存链对于改善接受ECPR患者的治疗结果至关重要。需要进一步研究以找到使用ECPR的最佳策略。
