Department of Intensive Care, Maastricht University Medical Center.
Department of Cardiothoracic Surgery, Maastricht University Medical Center Cardiovascular Research Institute Maastricht.
Curr Opin Crit Care. 2023 Dec 1;29(6):633-639. doi: 10.1097/MCC.0000000000001102. Epub 2023 Oct 20.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging treatment for refractory cardiac arrest. In recent years, several randomized controlled trials have been published that aimed to address the efficacy and effectiveness of ECPR for out-of-hospital cardiac arrest (OHCA). Despite the lack of high-quality evidence concerning clinical effectiveness and cost-effectiveness, ECPR is increasingly implemented throughout the world. In this review, we aim to provide an overview of the current status of ECPR for OHCA.
Randomized controlled trials showed diverging results, largely due to differences in selection criteria and study design. Single-center studies, performed in centers with extraordinary expertise and dedication consistently achieve a low-flow time of around 60 min, but such achievements are rarely reproduced outside these centers. Strict patient selection can improve outcome but simultaneously limits the caseload. Preliminary data suggest that outcome may also be improved by avoiding hyperoxia postresuscitation.
The potential of ECPR to increase survival in selected patients in highly dedicated systems seems to be proven, the question remains whether ECPR for OHCA can be widely implemented successfully and can develop into a sustainable, commonplace resource-effective treatment.
体外心肺复苏（ECPR）是一种治疗难治性心脏骤停的新兴疗法。近年来，发表了几项旨在解决院外心脏骤停（OHCA）中 ECPR 的疗效和有效性的随机对照试验。尽管缺乏关于临床效果和成本效益的高质量证据，但 ECPR 在全球范围内的应用越来越广泛。在这篇综述中，我们旨在概述 ECPR 在 OHCA 中的现状。
随机对照试验的结果存在差异，主要是由于选择标准和研究设计的差异。在具有非凡专业知识和奉献精神的中心进行的单中心研究始终实现了约 60 分钟的低血流时间，但这些中心之外很少能重现这些结果。严格的患者选择可以改善预后，但同时限制了病例量。初步数据表明，避免复苏后过度氧合也可能改善预后。
在高度专注的系统中，ECPR 有可能增加选定患者的存活率，问题仍然是 OHCA 的 ECPR 是否可以成功广泛实施，并发展成为一种可持续的、常规的资源有效的治疗方法。
