院外心脏骤停需体外心肺复苏的成年患者中与良好功能转归相关的预后因素：一项系统综述和荟萃分析
Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis.
作者信息
Tran Alexandre, Rochwerg Bram, Fan Eddy, Belohlavek Jan, Suverein Martje M, Poll Marcel C G van de, Lorusso Roberto, Price Susanna, Yannopoulos Demetris, MacLaren Graeme, Ramanathan Kollengode, Ling Ryan Ruiyang, Thiara Sonny, Tonna Joseph E, Shekar Kiran, Hodgson Carol L, Scales Damon C, Sandroni Claudio, Nolan Jerry P, Slutsky Arthur S, Combes Alain, Brodie Daniel, Fernando Shannon M
机构信息
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
出版信息
Resuscitation. 2023 Dec;193:110004. doi: 10.1016/j.resuscitation.2023.110004. Epub 2023 Oct 18.
BACKGROUND
Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established.
METHODS
We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach.
FINDINGS
We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes).
INTERPRETATION
The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.
背景
体外心肺复苏（ECPR）在难治性院外心脏骤停（OHCA）的管理中已显示出前景。然而，观察性研究和临床试验的证据相互矛盾，且影响预后的因素尚未明确。
方法
我们进行了一项系统评价和荟萃分析，总结了接受OHCA的ECPR成年患者的ECPR前预后因素与良好功能预后可能性之间的关联。我们检索了从数据库建立至2023年2月28日的Medline和Embase数据库，并由两名独立评审员筛选研究。我们分别对未调整和调整后的比值比、调整后的风险比和均值差异进行了荟萃分析。我们使用QUIPS工具评估偏倚风险，使用GRADE方法评估证据的确定性。
结果
我们纳入了29项观察性和随机研究，涉及7397名患者。与良好功能预后生存增加具有中度或高度关联确定性的因素包括心脏骤停前患者因素，如年龄较小（比值比（OR）2.13，95%可信区间1.52至2.99）和女性（OR 1.37，95%可信区间1.11至1.70），以及心脏骤停期间因素，如可电击心律（OR 2.79，95%可信区间2.04至3.80）、目击心脏骤停（OR 1.68（95%可信区间1.16至2.42））、旁观者心肺复苏（OR 1.55，95%可信区间1.19至2.01）、自主循环恢复（OR 2.81，95%可信区间2.19至3.61）和较短的插管时间（每10分钟OR 1.14，95%可信区间1.17至1.69）。
解读
本综述的结果证实了心脏骤停文献中确立的几个临床概念及其对考虑进行ECPR的患者的适用性——即既往患者因素的影响、及时有效心肺复苏的益处，以及尽量缩短低血流时间的预后重要性。我们主张在评估患者进行ECPR的潜在候选资格时，将这些预后因素作为风险分层框架的一部分进行深思熟虑的考虑。
Zotero 插件