Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
Chest. 2024 Apr;165(4):858-869. doi: 10.1016/j.chest.2023.10.022. Epub 2023 Oct 23.
A better understanding of the relative contributions of various factors to patient outcomes is essential for optimal patient selection for extracorporeal CPR (ECPR) therapy for patients with out-of-hospital cardiac arrest (OHCA). However, evidence on the prognostic comparison based on the etiologies of cardiac arrest is limited.
What is the etiology-based prognosis of patients undergoing ECPR for OHCA?
This retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurologic outcome and survival at hospital discharge.
We identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest because of cardiac causes. Multivariable logistic regression analysis for favorable neurologic outcome showed that accidental hypothermia (adjusted OR, 5.12; 95% CI, 2.98-8.80; P < .001) was associated with a significantly higher rate of favorable neurologic outcome than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR, 5.19; 95% CI, 3.15-8.56; P < .001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR, 0.07; 95% CI, 0.02-0.28; P < .001) and primary cerebral disorders (adjusted OR, 0.12; 95% CI, 0.03-0.50; P = .004) had significantly lower rates of survival than cardiac causes.
In this retrospective multicenter cohort study, although most patients with OHCA underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurologic outcome and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with nonsurvival compared with cardiac causes.
为了优化体外心肺复苏（ECPR）治疗院外心脏骤停（OHCA）患者的患者选择，更好地了解各种因素对患者结局的相对贡献至关重要。然而，基于心脏骤停病因的预后比较证据有限。
接受 ECPR 治疗 OHCA 的患者的病因预后如何？
这是一项回顾性多中心登记研究，涉及日本的 36 家机构，纳入 2013 年 1 月至 2018 年 12 月期间接受 ECPR 的所有成年 OHCA 患者。每个机构均从所有基于医院的数据中回顾性确定 OHCA 的主要病因。我们进行了多变量逻辑回归模型，以确定心脏骤停病因与两种结局之间的关系：神经功能良好和出院时存活。
我们确定了 1781 名符合条件的患者，其中 1405 名（78.9%）因心脏原因发生心脏骤停。多变量逻辑回归分析显示，意外低温（调整后的优势比，5.12；95%CI，2.98-8.80；P<0.001）与神经功能良好的发生率显著高于心脏原因。多变量逻辑回归分析显示，意外低温（调整后的优势比，5.19；95%CI，3.15-8.56；P<0.001）的存活率显著高于心脏原因。急性主动脉夹层/动脉瘤（调整后的优势比，0.07；95%CI，0.02-0.28；P<0.001）和原发性脑疾病（调整后的优势比，0.12；95%CI，0.03-0.50；P=0.004）的存活率显著低于心脏原因。
在这项回顾性多中心队列研究中，尽管大多数 OHCA 患者因心脏原因接受 ECPR，但意外低温与神经功能良好和存活相关；相反，急性主动脉夹层/动脉瘤和原发性脑疾病与心脏原因相比与非存活相关。
