实时超声引导下心肺复苏体外循环置管的省时效果：一项多中心回顾性队列研究。
Time-saving effect of real-time ultrasound-guided cannulation for extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study.
机构信息
Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA.
Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, Japan.
出版信息
Resuscitation. 2023 Oct;191:109927. doi: 10.1016/j.resuscitation.2023.109927. Epub 2023 Aug 6.
BACKGROUND
Extracorporeal cardiopulmonary resuscitation (ECPR), a bridge to treatments for cardiac arrest patients, can be technically challenging and requires expertise. While ultrasound guidance is frequently used for vascular access, its effects on cannulation time in patients treated with ECPR are poorly defined. We hypothesized that real-time ultrasound guidance would contribute to faster and safer cannulation for ECPR.
METHODS
This nationwide, multicenter, retrospective study analyzed data from 36 Japanese institutions. Patients who were over age 18 years and underwent ECPR between January 1, 2013, and December 31, 2018, were included. Patients who underwent open surgical vascular access were excluded. Cannulation time and outcomes of patients who underwent real-time ultrasound-guided cannulation (i.e., ultrasound-guided group) were compared to those cannulated without the use of real-time ultrasound guidance (control group) using propensity score matching analysis.
RESULTS
The ultrasound-guided group comprised 510 cases, whereas the control group comprised 941 cases. Of those, 443 propensity score-matched pairs were evaluated. Cannulation time in the ultrasound-guided group was 2.5 minutes shorter than in the control group [difference, -2.5 minutes; 95% Confidence interval (CI), -3.7 to -1.3, p < 0.001]. The incidence of catheter-related complications and the incidence of the poor neurological outcomes (Cerebral Performance Category ≥3) did not differ between groups [Odds ratio (OR), 1.51; 95% CI, 0.64-3.74; OR, 1.08; 95% CI, 0.83-1.59].
CONCLUSION
Real-time ultrasound-guided cannulation was associated with shorter cannulation time of ECPR.
背景
体外心肺复苏（ECPR）是心脏骤停患者治疗的桥梁，但技术难度大，需要专业知识。虽然超声引导常用于血管通路，但在接受 ECPR 治疗的患者中，其对置管时间的影响尚不清楚。我们假设实时超声引导将有助于更快、更安全地进行 ECPR 置管。
方法
这是一项全国性的多中心回顾性研究，分析了来自 36 家日本机构的数据。纳入年龄大于 18 岁并于 2013 年 1 月 1 日至 2018 年 12 月 31 日期间接受 ECPR 的患者。排除接受开放式血管手术通路的患者。使用倾向评分匹配分析比较接受实时超声引导置管（即超声引导组）和未使用实时超声引导置管（对照组）的患者的置管时间和结局。
结果
超声引导组有 510 例，对照组有 941 例。其中，443 对进行了倾向评分匹配。超声引导组的置管时间比对照组短 2.5 分钟[差值，-2.5 分钟；95%置信区间（CI），-3.7 至-1.3，p < 0.001]。两组导管相关并发症的发生率和不良神经结局（脑功能状态分类≥3）的发生率无差异[比值比（OR），1.51；95%CI，0.64-3.74；OR，1.08；95%CI，0.83-1.59]。
结论
实时超声引导置管与 ECPR 置管时间缩短有关。
Zotero 插件