Chahine Johnny, Kosmopoulos Marinos, Raveendran Ganesh, Yannopoulos Demetris, Bartos Jason A
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.
Resuscitation. 2023 Dec;193:109998. doi: 10.1016/j.resuscitation.2023.109998. Epub 2023 Oct 12.
Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior studies of the impact of age on outcomes in ECPR have demonstrated mixed results and we aim to investigate this relationship.
Patients treated with ECPR at the University of Minnesota Medical Center for refractory out-of-hospital VT/VF arrest from December 2015 to February 2023 were included. The primary endpoints included neurologically favorable survival to discharge. A receiver operating characteristic curve was used to determine an optimal predictive age limit with the highest accuracy for neurologically favorable survival.
391 consecutive patients were included: 22% (n = 86) were female and the mean age was 56.9 ± 11.8 years. Age was independently associated with neurologically favorable survival to discharge, with a 30% decrease in survival with every 10-year increase in age (OR 0.7 (0.57-0.87), p = 0.001. Among those with neurologically favorable survival to discharge, older patients had longer length of hospital stay compared to younger age groups (p = 0.002) while patients who failed to achieve neurologically favorable survival to discharge had similar length of stay independent of age (p = 0.51).
Age is associated with neurologically favorable survival to discharge for patients receiving ECPR for refractory out-of-the-hospital VT/VF cardiac arrest. However, with a survival rate of 23% in the oldest age group, caution should be used when choosing age criteria for patient selection.
体外心肺复苏（ECPR）已被证明可提高难治性室性心动过速（VT）/室颤（VF）导致的院外心脏骤停患者神经功能良好的生存率。先前关于年龄对ECPR结局影响的研究结果不一，我们旨在研究这种关系。
纳入2015年12月至2023年2月在明尼苏达大学医学中心接受ECPR治疗的难治性院外VT/VF心脏骤停患者。主要终点包括神经功能良好的出院生存率。采用受试者工作特征曲线确定对神经功能良好的生存具有最高准确性的最佳预测年龄界限。
共纳入391例连续患者：22%（n = 86）为女性，平均年龄为56.9±11.8岁。年龄与神经功能良好的出院生存率独立相关，年龄每增加10岁，生存率降低30%（OR 0.7（0.57 - 0.87），p = 0.001）。在神经功能良好出院的患者中，老年患者的住院时间比年轻患者长（p = 0.002），而未实现神经功能良好出院的患者住院时间与年龄无关（p = 0.51）。
对于因难治性院外VT/VF心脏骤停接受ECPR治疗的患者，年龄与神经功能良好的出院生存率相关。然而老年年龄组生存率为23%，在选择患者的年龄标准时应谨慎。
