体外心肺复苏治疗院外心脏骤停患者的低流量时间和结局。
Low-flow time and outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation.
机构信息
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
出版信息
Am J Emerg Med. 2024 Jan;75:37-41. doi: 10.1016/j.ajem.2023.10.024. Epub 2023 Oct 21.
INTRODUCTION
In out-of-hospital cardiac arrest (OHCA) patients with extracorporeal cardiopulmonary resuscitation (ECPR), the association between low-flow time, the duration between the initiation of conventional cardiopulmonary resuscitation and the establishment of ECPR, and outcomes has not been clearly determined.
METHODS
This was a secondary analysis of the retrospective multicenter registry in Japan. This study registered patients ≥18 years old who were admitted to the emergency department for OHCA and underwent ECPR between January, 2013 and December, 2018. Low-flow time was defined as the time from initiation of conventional cardiopulmonary resuscitation to the establishment of ECPR, and patients were categorized into two groups according to the visualized association of the restricted cubic spline curve. The primary outcome was survival discharge. Cubic spline analyses and multivariable logistic regression analyses were performed to assess the nonlinear associations between low-flow time and outcomes.
RESULTS
A total of 1,524 patients were included. The median age was 60 years, and the median low-flow time was 52 (42-53) mins. The overall survival at hospital discharge and favorable neurological outcomes were 27.8% and 14.2%, respectively. The cubic spline analysis showed a decreased trend of survival discharge rates and favorable neurological outcomes with shorter low-flow time between 20 and 60 mins, with little change between the following 60 and 80 mins. The multivariable logistic regression analyses showed that patients with long low-flow time (>40 mins) compared to those with short low-flow time (0-40 mins) had significantly worse survival (adjusted odds ratio 0.42; 95% confidence intervals, 0.31-0.57) and neurological outcomes (0.65; 0.45-0.95, respectively).
CONCLUSIONS
The survival discharge and neurological outcomes of patients with low-flow time shorter than 40 min are better than those of patients with longer low-flow time.
简介
在院外心脏骤停（OHCA）患者中进行体外心肺复苏（ECPR）时，低流量时间（从开始常规心肺复苏到建立 ECPR 的时间）与结局之间的关系尚未明确。
方法
这是日本回顾性多中心登记处的二次分析。本研究登记了 2013 年 1 月至 2018 年 12 月期间因 OHCA 入住急诊科并接受 ECPR 的年龄≥18 岁的患者。低流量时间定义为从开始常规心肺复苏到建立 ECPR 的时间，并根据受限立方样条曲线的直观关联将患者分为两组。主要结局是存活出院。进行了立方样条分析和多变量逻辑回归分析，以评估低流量时间与结局之间的非线性关系。
结果
共纳入 1524 例患者。中位年龄为 60 岁，中位低流量时间为 52（42-53）分钟。出院时的总体存活率和良好的神经功能结局分别为 27.8%和 14.2%。立方样条分析显示，在 20-60 分钟的低流量时间范围内，存活出院率和良好的神经功能结局呈下降趋势，而在接下来的 60-80 分钟内变化不大。多变量逻辑回归分析显示，与低流量时间短（0-40 分钟）的患者相比，低流量时间长（>40 分钟）的患者存活（调整优势比 0.42；95%置信区间，0.31-0.57）和神经功能结局（0.65；0.45-0.95）更差。
结论
低流量时间短于 40 分钟的患者的存活出院和神经功能结局优于低流量时间长的患者。
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